Jacob Nicholas Reynolds, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1106244 Issued in KS

Practice address

1311 Wakarusa Dr Ste 1000
Lawrence, KS 66049-1741

Phone

(785) 749-1300

Fax

(785) 749-4746

NPI assigned

Oct 16, 2019

Last updated

Oct 16, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1571184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1336781830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 WAKARUSA DR STE 1000",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660491741",
            "telephone_number": "785-749-1300",
            "fax_number": "785-749-4746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 WAKARUSA DR STE 1000",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660491741",
            "telephone_number": "785-749-1300",
            "fax_number": "785-749-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "JACOB",
        "middle_name": "NICHOLAS",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-16",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "1106244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1106244",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "billing@therapyworkskansas.com",
            "affiliation": "N",
            "address_1": "1311 Wakarusa Dr Ste 1000",
            "city": "Lawrence",
            "state": "KS",
            "country_code": "US",
            "postal_code": "660491741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Lawrence, KS
• Providers in Lawrence, KS by specialty
• Physical Therapist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.

Verify at the official NPI Registry.