Active NPI
Clarissa Lynn Jacobson, PT
- Physical Therapist
- Johnston, IA
National Provider Identifier
1508902586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01457
- Practice address
- 8301 Talbot PL
Johnston, IA 50131-8761 - Phone
- (515) 278-2625
- NPI assigned
- Jan 29, 2007
- Last updated
- Jul 8, 2007
- 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 | 01457 | IA | Primary |
Addresses
Primary practice location
8301 Talbot PL
Johnston, IA 50131-8761
Mailing address
6500 Corporate Drive
Johnston, IA 50131-8761
Phone (515) 270-9030
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 |
|---|---|---|---|
| 01457 | IA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508902586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6500 CORPORATE DRIVE",
"city": "JOHNSTON",
"state": "IA",
"postal_code": "501318761",
"telephone_number": "515-270-9030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8301 TALBOT PL",
"city": "JOHNSTON",
"state": "IA",
"postal_code": "501318761",
"telephone_number": "515-278-2625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "CLARISSA",
"middle_name": "LYNN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IA",
"license": "01457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnston, IA
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.