Individual provider Active NPI

Mimi Jacobs, PT

  • Physical Therapist
  • Cherry Hill, NJ
National Provider Identifier
1508998543
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA00942100 Issued in NJ
Practice address
801 Kings Hwy N
Fox Rehabilitation
Cherry Hill, NJ 08034-1513
Phone
(877) 407-3422
Fax
(877) 407-4329
NPI assigned
Mar 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA00942100 NJ Primary

Addresses

Primary practice location

801 Kings Hwy N
Fox Rehabilitation
Cherry Hill, NJ 08034-1513

Mailing address

5 Birchwood Dr
Medford, NJ 08055-9239
Phone (877) 407-3422

Other names 1

  • Mimi Zlatkowski Former name

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

State licenses

LicenseStateTypeSpecialty
40QA00942100NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Physical Therapy of New York, P.C. Physical Therapist PastSince Dec 11, 2013 Accepting new patients
Fox Rehabilitation Services Inc Physical Therapist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508998543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BIRCHWOOD DR",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080559239",
            "telephone_number": "877-407-3422",
            "fax_number": "877-407-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 KINGS HWY N",
            "address_2": "FOX REHABILITATION",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080341513",
            "telephone_number": "877-407-3422",
            "fax_number": "877-407-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MIMI",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00942100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIMI",
            "last_name": "ZLATKOWSKI",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cherry Hill, NJ

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.

Verify at the official NPI Registry.