Jacob T Bartz-Broussard, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT5929 Issued in ME

Practice address

36 Workman Ter
Lincoln, ME 04457-1162

Phone

(207) 794-6025

NPI assigned

May 14, 2021

Sex

Male

Sole proprietor

No

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, last updated by the provider on May 14, 2021.

{
    "created_epoch": "1620950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1386218352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 COURTHOUSE RD UNIT 22",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395074111",
            "telephone_number": "228-265-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 WORKMAN TER",
            "city": "LINCOLN",
            "state": "ME",
            "postal_code": "044571162",
            "telephone_number": "207-794-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTZ-BROUSSARD",
        "first_name": "JACOB",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-14",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT5929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lincoln, ME
• Physical Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.