Jacob Gross
Individual provider Active NPI Physical Therapy Assistant · Stanford, KY
NPI 1063138337 · NPPES record last updated Oct 18, 2022
Key facts
- NPI
- 1063138337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- Practice address
- 105 Harmon HTS
Stanford, KY 40484-1111 - Phone
- (606) 369-2141
- NPI assigned
- Oct 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | Yes |
Addresses
Primary practice location
105 Harmon HTS
Stanford, KY 40484-1111
Mailing address
79 Norwood Dr
Science Hill, KY 42553-9325
Other providers in Stanford, KY
- Fresenius Medical Care Stanford, LLC
- Scott T Garland
- Teresa Gesin
- Lone S Gooch
- Taylor Graves
- Allison Stigall Grubbs
- Brittany M Hager
- Brittany Hall
- Donna C Hankla
- Sharon D Hardy
All providers in Stanford, KY · Physical Therapy Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.