Jacob Ryan Ellingson, MSPT, SCS, ATC, CSCS

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

6749 Issued in MN

Practice address

301 Highway 65 S
Mora, MN 55051-1899

Phone

(320) 225-3356

Fax

(320) 225-3370

NPI assigned

Jan 23, 2006

Last updated

Jul 9, 2014By 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)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jellingson146782@excellian.direct.allina.com

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.

• Sportsplus Physical Therapy GC LLC

  • Physical Therapy Clinic/Center
  • Grundy Center, IA
  • NPI 1790140234

  Sports

  NPD (past)
• Sportsplus Sports Medicine and Physical Therapy Center Inc

  • Physical Therapy Clinic/Center
  • Marshalltown, IA
  • NPI 1467422014
  NPD (past)

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404864000000",
    "number": "1346210432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HIGHWAY 65 S",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511899",
            "telephone_number": "320-225-3356",
            "fax_number": "320-225-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HIGHWAY 65 S",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511899",
            "telephone_number": "320-225-3356",
            "fax_number": "320-225-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "JACOB",
        "middle_name": "RYAN",
        "credential": "MSPT, SCS, ATC, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2014-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "MN",
            "license": "6749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Erika Dubay, MD
• Kati Jean Dvorak, PHARM D
• Eagle's Crossing Adult Day Center (Mora Eaglet)
• East Central Behavioral Health LLC
• Tasha Eggert, LADC
• Barbara Lou Ennis, NP
• Garrett Estenson, PT, DPT, MBA
• Sara Lee Estenson, PT
• Jodie M Evenson, LADC
• Siegfried Feierabend, MD

• Sports Physical Therapist in Mora, MN
• Providers in Mora, MN by specialty
• Sports Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.