Mirasol Ame Jacobs, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

27051 Issued in MD

Practice address

30 E Padonia Rd Ste 104
Timonium, MD 21093-2347

Phone

(410) 821-5151

Fax

(410) 823-8309

NPI assigned

May 27, 2020

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

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Serc Rehabilitation Partners, LLC

  • Physical Therapist
  • Belton, MO
  • NPI 1760745244
  Medicare reassignment NPD
• Serc Rebabilitation Partners, LLC

  • Physical Therapist
  • Overland Park, KS
  • NPI 1598190209
  NPD

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1467075259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E PADONIA RD STE 104",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932347",
            "telephone_number": "410-821-5151",
            "fax_number": "410-823-8309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E PADONIA RD STE 104",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932347",
            "telephone_number": "410-821-5151",
            "fax_number": "410-823-8309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MIRASOL",
        "middle_name": "AME",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-27",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "27051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Micaela Itter
• Mohammad - Izadidehkordi, D.D.S
• Jackson Professional Associates LLC
• Brenda Jackson, OT
• Shakira Jackson
• Susannah Jo Jane, DPT
• Alexander Arthur Jasion, LGPC
• Charlotte Jeanne, LCPC
• Akira Jennings
• Per K Jensen, OT

• Physical Therapist in Timonium, MD
• Providers in Timonium, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.