Jacob Proffit, DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11965771-2401 Issued in UT

Practice address

209 W 300 N
Logan, UT 84321-3809

Phone

(435) 716-8535

NPI assigned

Feb 9, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wasatch Therapy IncGroup PAC ID 3476524760, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Wasatch Therapy Inc

  • Physical Therapy Clinic/Center
  • Farmington, UT
  • NPI 1780894485

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Wasatch Therapy Inc

  • Physical Therapy Clinic/Center
  • Layton, UT
  • NPI 1235482977
  NPD

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

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1154185148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9195 N 6400 W",
            "city": "TREMONTON",
            "state": "UT",
            "postal_code": "843378603",
            "telephone_number": "425-512-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W 300 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843213809",
            "telephone_number": "435-716-8535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFFIT",
        "first_name": "JACOB",
        "credential": "DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "UT",
            "license": "11965771-4810",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "11965771-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cristine Price, LPC, LSAC, NCSP
• Tanner Egan Price, AUD
• Thomas W Price, PA
• Tamra J.G. Priestley, ACMHC
• Kendal Pritchard, CMHC
• Madeleine Pugmire, LCSW
• Timothy Pulleyn
• Scott Pumphrey, DPT
• Michelle Stokes Purser, RDN, MDA
• Doriann Sheri Pye, CMHC

• Physical Therapist in Logan, UT
• Providers in Logan, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.