Ken R Jacobs, PT,MA

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1131 Issued in AZ

Practice address

3285 E Sparrow Ave
Flagstaff, AZ 86004-7794

Phone

(928) 627-6163

Fax

(928) 527-6181

NPI assigned

Apr 17, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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.

• Flagstaff Unified School District

  • Student in an Organized Health Care Education/Training Program
  • Flagstaff, AZ
  • NPI 1275747206
  NPD (past)
• Flagstaff Unified School District #1

  • Local Education Agency (LEA)
  • Flagstaff, AZ
  • NPI 1407982226
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447476775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18719 N BASE CAMP RD",
            "address_2": "HART PRAIRIE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860019377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3285 E SPARROW AVE",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860047794",
            "telephone_number": "928-627-6163",
            "fax_number": "928-527-6181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "KEN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PT,MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "1131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD LICENSE",
            "identifier": "1131",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J & S Medical, PC
• Robin Jackson, DAC
• Alexander C Jacobs, M.D.
• Christina Quevedo Jacobs
• Julia A Jacobs, M.D.
• Kirsten Melissa Jacobsen Hearne, R.N.
• Jada Therapy PLLC
• Tarang Kumar Jain
• Jake Garn DDS PLLC
• Clare Louise Jakob

• Physical Therapist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.