Jacob Lively

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

526 SW 4TH St Ste 200
Moore, OK 73160-5409

Phone

(405) 759-2700

Fax

(405) 759-2722

NPI assigned

Jan 28, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cutting Edge Physical Therapy PLLC

  • Physical Therapy Clinic/Center
  • Moore, OK
  • NPI 1508272006
  NPD
• Cutting Edge Physical Therapy PLLC

  • Physical Therapy Clinic/Center
  • Yukon, OK
  • NPI 1205352028
  NPD (past)

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1407447998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 SW 4TH ST STE 200",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731605409",
            "telephone_number": "405-759-2700",
            "fax_number": "405-759-2722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 SW 4TH ST STE 200",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731605409",
            "telephone_number": "405-759-2700",
            "fax_number": "405-759-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVELY",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "app.webpt.com",
            "affiliation": "N",
            "endpointDescription": "Webpt EMR",
            "address_1": "526 SW 4th St Ste 200",
            "city": "Moore",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731605409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lightwork Psychological Services LLC
• Naoma C Likens
• Tristan Lilley, MD
• Kinsey Brooke Littledeer
• Live Well Therapy LLC
• Chacy Emmanuel Ong Llido
• Andrea Loftis, LPC
• Leah Marie Logan, MS, LPC
• Tyler Aaron Logan
• Lucia Lomo-Aidoo, RN

• Physical Therapy Assistant in Moore, OK
• Providers in Moore, OK by specialty
• Physical Therapy Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.