Jacob Kelley Frederick, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2025017762 Issued in MO

Practice address

3074 Winghaven Blvd
O Fallon, MO 63368-3620

Phone

(636) 265-4100

NPI assigned

May 28, 2025

Last updated

May 28, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Elite Physical Therapy of Ofallon, LLC

  dba CORA Physical Therapy - O'Fallon

  • Rehabilitation Clinic/Center
  • O'Fallon, MO
  • NPI 1326578626

  Physical Therapist

  NPD
• Physical Therapy Spine & Sports Medicine LLC

  dba CORA Physical Therapy - St. Peters

  • Rehabilitation Clinic/Center
  • Saint Peters, MO
  • NPI 1194454090
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1124811393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3513 BROOKSIDE CROSSING DR",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633014901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3074 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683620",
            "telephone_number": "636-265-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "JACOB",
        "middle_name": "KELLEY",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-28",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2025017762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Rae Fox, LPC
• Fran-Tic Enterprises (St. Charles County Cab)
• Lindsay Nicole Frank, CRNA
• Ryan Franklin
• Erin Corsi Fraundorf, DMD, MS
• Jennifer Jo Freeling, MPT
• Darla J Freiner
• Natasha Brooke Fresenburg, PA-C
• Fresenius Medical Care of O'Fallon
• Susan Patricia Frew, M.A., L.P.C., N.C.C.

• Physical Therapist in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.