Ellicia Jacobs, PT,DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305209780 Issued in VA

Practice address

9447B Lorton Market St
Suite 250
Lorton, VA 22079-1963

Phone

(703) 372-5716

Fax

(703) 372-5718

NPI assigned

Sep 15, 2015

Sex

Female

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

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442275200000",
    "number": "1407224934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9447B LORTON MARKET ST",
            "address_2": "SUITE 250",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220791963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9447B LORTON MARKET ST",
            "address_2": "SUITE 250",
            "city": "LORTON",
            "state": "VA",
            "postal_code": "220791963",
            "telephone_number": "703-372-5716",
            "fax_number": "703-372-5718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "ELLICIA",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305209780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Lorton, VA
• Providers in Lorton, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.