Active NPI
Anthony B Jacobs, PTA
- Physical Therapy Assistant
- Ontario, CA
National Provider Identifier
1114656246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 50823
- Practice address
- 732 Hollowell St
Ontario, CA 91762-3306 - Phone
- (909) 437-9767
- NPI assigned
- Jun 6, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 50823 | CA | Primary |
Addresses
Primary practice location
732 Hollowell St
Ontario, CA 91762-3306
Mailing address
732 Hollowell St
Ontario, CA 91762-3306
Phone (909) 437-9767
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 |
|---|---|---|---|
| 50823 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654473600000",
"number": "1114656246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "732 HOLLOWELL ST",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917623306",
"telephone_number": "909-437-9767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "732 HOLLOWELL ST",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917623306",
"telephone_number": "909-437-9767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "ANTHONY",
"middle_name": "B",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-06",
"last_updated": "2022-06-06",
"certification_date": "2022-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "50823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.