Active NPI
Kevin J. Jacobs, PT
- Physical Therapist
- Waterbury, CT
National Provider Identifier
1194751065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 006905
- Practice address
- 500 Chase Pkwy
Waterbury, CT 06708-3346 - Phone
- (203) 754-2266
- Fax
- (203) 591-8680
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- Sole proprietor
- No
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 Therapist | 225100000X | 006905 | CT | Primary |
Addresses
Primary practice location
500 Chase Pkwy
Waterbury, CT 06708-3346
Mailing address
31 Old Route 7
Brookfield, CT 06804-1714
Phone (203) 740-0020
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carlson Therapy Network, PC | 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 and National Provider Directory roles.
-
- Physical Therapist
- New Milford, CT
- NPI 1114979226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194751065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 OLD ROUTE 7",
"city": "BROOKFIELD",
"state": "CT",
"postal_code": "068041714",
"telephone_number": "203-740-0020",
"fax_number": "203-775-0238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 CHASE PKWY",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067083346",
"telephone_number": "203-754-2266",
"fax_number": "203-591-8680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "KEVIN",
"middle_name": "J.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "006905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.