Active NPI
Kelly Jo Jacobs, DPT
- Physical Therapist
- Fort Wayne, IN
National Provider Identifier
1508522236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05011070A
- Practice address
- 415 E Cook Rd Ste 600
Fort Wayne, IN 46825-3657 - Phone
- (260) 226-7329
- Fax
- (260) 226-7330
- NPI assigned
- Nov 17, 2021
- Sex
- Female
- 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 | 05011070A | IN | Primary |
Addresses
Primary practice location
415 E Cook Rd Ste 600
Fort Wayne, IN 46825-3657
Mailing address
415 E Cook Rd Ste 600
Fort Wayne, IN 46825-3657
Phone (260) 226-7329
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637107200000",
"number": "1508522236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 E COOK RD STE 600",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468253657",
"telephone_number": "260-226-7329",
"fax_number": "260-226-7330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 E COOK RD STE 600",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468253657",
"telephone_number": "260-226-7329",
"fax_number": "260-226-7330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "KELLY",
"middle_name": "JO",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-17",
"last_updated": "2021-11-17",
"certification_date": "2021-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05011070A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.