Active NPI
Kimberly Ann Jacob, PT
- Geriatric Physical Therapist
- Colorado Springs, CO
National Provider Identifier
1306133608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 6841
- Practice address
- 1685 S 21St St
Colorado Springs, CO 80904-5123 - Phone
- (719) 329-1774
- NPI assigned
- Jul 7, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 6841 | CO | Primary |
Addresses
Primary practice location
1685 S 21St St
Colorado Springs, CO 80904-5123
Mailing address
P. O. Box 77132
Colorado Springs, CO 80970
Phone (719) 201-0543
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 |
|---|---|---|---|
| 6841 | CO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1306133608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P. O. BOX 77132",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "80970",
"telephone_number": "719-201-0543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1685 S 21ST ST",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809045123",
"telephone_number": "719-329-1774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-07",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "CO",
"license": "6841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.