Individual provider Active NPI

Emily Jacobson, DPT

  • Physical Therapist
  • Sheboygan, WI
National Provider Identifier
1104284025
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
13031-024 Issued in WI
Practice address
1414 N Taylor Dr
Sheboygan, WI 53081-1988
Phone
(920) 476-6300
NPI assigned
Feb 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 13031-024 WI Primary

Addresses

Primary practice location

1414 N Taylor Dr
Sheboygan, WI 53081-1988

Mailing address

1414 N Taylor Dr
Sheboygan, WI 53081-1988
Phone (920) 320-3100

Other identifiers 1

IdentifierTypeStateIssuer
1104284025MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160318001464 WI Practitioner - Physical Therapist in Private Practice 6204133267 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Froedtert Manitowoc Medical Group, LLCGroup PAC ID 2365836954, 156 clinicians

Practice addresses (Care Compare)

1414 N Taylor Dr
Sheboygan, WI 53081-1988
Phone (920) 320-2436

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13031WIMDPharmacist
13031-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Physical Therapist Current Accepting new patients
Froedtert Manitowoc Medical Group, LLC CurrentSince May 17, 2025 Accepting new patients
Focus Physical Therapy LLC Physical Therapist CurrentSince Jan 1, 2022 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Feb 16, 2016 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Feb 16, 2016 Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

110 Lone Oak Ln
Hartford, WI 53027
Phone (262) 670-1800

1701 Fond du Lac Ave
Kewaskum, WI 53040
Phone (262) 626-4616

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

4805 S Moorland Rd
New Berlin, WI 53151
Phone (262) 798-7200

1505 Eastern Ave
Plymouth, WI 53073
Phone (920) 893-6070

1414 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 320-2011

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

Organizations & group practices 5

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": "1454630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1104284025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 N TAYLOR DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811988",
            "telephone_number": "920-320-3100",
            "fax_number": "920-320-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 N TAYLOR DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811988",
            "telephone_number": "920-476-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "EMILY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-05",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "13031-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104284025",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.