Active NPI
Jacob Towell, PT
- Physical Therapist
- Wynne, AR
National Provider Identifier
1063816049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 3890
- Practice address
- 707 Eldridge Ave E
Wynne, AR 72396-4032 - Phone
- (870) 208-8989
- Fax
- (870) 208-8989
- NPI assigned
- Oct 20, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 3890 | AR | Primary |
Addresses
Primary practice location
707 Eldridge Ave E
Wynne, AR 72396-4032
Mailing address
707 Eldridge Ave E
Wynne, AR 72396-4032
Phone (870) 208-8989
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT 3890 | Other | AR | PHYSICAL THERAPIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 3890 | AR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boaz & Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413763200000",
"number": "1063816049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 ELDRIDGE AVE E",
"city": "WYNNE",
"state": "AR",
"postal_code": "723964032",
"telephone_number": "870-208-8989",
"fax_number": "870-208-8989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 ELDRIDGE AVE E",
"city": "WYNNE",
"state": "AR",
"postal_code": "723964032",
"telephone_number": "870-208-8989",
"fax_number": "870-208-8989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOWELL",
"first_name": "JACOB",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-20",
"last_updated": "2014-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "PT 3890",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPIST",
"identifier": "PT 3890",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wynne, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.