Active NPI
Bruce A Jacobsen, PT
- Physical Therapist
- Branford, CT
National Provider Identifier
1477768653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 004093
- Practice address
- 84 N Main St
Branford, CT 06405-3009 - Phone
- (203) 789-3490
- Fax
- (203) 488-7129
- NPI assigned
- May 11, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 004093 | CT | Primary |
Addresses
Primary practice location
84 N Main St
Branford, CT 06405-3009
Mailing address
52 White Birch Dr
Guilford, CT 06437-2159
Phone (203) 458-3466
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004093 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477768653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52 WHITE BIRCH DR",
"city": "GUILFORD",
"state": "CT",
"postal_code": "064372159",
"telephone_number": "203-458-3466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "84 N MAIN ST",
"city": "BRANFORD",
"state": "CT",
"postal_code": "064053009",
"telephone_number": "203-789-3490",
"fax_number": "203-488-7129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "BRUCE",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "004093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Branford, CT
Sources for this page
- 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.