Active NPI
Regina Renee Jacobs, PT
- Physical Therapist
- Harrah, OK
National Provider Identifier
1124040290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3653
- Practice address
- 19629 NE 23Rd St
Harrah, OK 73045 - Phone
- (405) 454-0010
- Fax
- (405) 454-0030
- NPI assigned
- Jul 24, 2006
- Last updated
- Nov 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 3653 | OK | |
| Physical Therapist | 225100000X | 3653 | OK | Primary |
Addresses
Primary practice location
19629 NE 23Rd St
Harrah, OK 73045
Mailing address
PO Box 746
Harrah, OK 73045
Phone (405) 454-0010
Other names 1
- Mrs. Regina Renee Holland
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3653 | OK | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HJ Enterprises | Physical Therapist | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573171200000",
"number": "1124040290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 746",
"city": "HARRAH",
"state": "OK",
"postal_code": "73045",
"telephone_number": "405-454-0010",
"fax_number": "405-454-0030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19629 NE 23RD ST",
"city": "HARRAH",
"state": "OK",
"postal_code": "73045",
"telephone_number": "405-454-0010",
"fax_number": "405-454-0030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "REGINA",
"middle_name": "RENEE",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2019-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OK",
"license": "3653",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "3653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "REGINA",
"last_name": "HOLLAND",
"middle_name": "RENEE",
"prefix": "MRS.",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Harrah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.