Active NPI
Jacob Derstine, DPT
- Physical Therapist
- Sellersville, PA
National Provider Identifier
1528675741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT022829
- Practice address
- 3250 State Rd
Sellersville, PA 18960-1624 - Phone
- (215) 257-2751
- Fax
- (215) 257-7390
- NPI assigned
- Sep 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | PT022829 | PA | Primary |
Addresses
Primary practice location
3250 State Rd
Sellersville, PA 18960-1624
Mailing address
758 Salfordville Rd
Harleysville, PA 19438-2107
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 |
|---|---|---|---|
| PT022829 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601424000000",
"number": "1528675741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "758 SALFORDVILLE RD",
"city": "HARLEYSVILLE",
"state": "PA",
"postal_code": "194382107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 STATE RD",
"city": "SELLERSVILLE",
"state": "PA",
"postal_code": "189601624",
"telephone_number": "215-257-2751",
"fax_number": "215-257-7390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERSTINE",
"first_name": "JACOB",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-30",
"last_updated": "2020-09-30",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT022829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sellersville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.