Active NPI
Jacob Papanicolas
- Physical Therapist
- Grants Pass, OR
National Provider Identifier
1538046222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 64068
- Practice address
- 402 SE G St
Grants Pass, OR 97526-3066 - Phone
- (541) 476-1583
- NPI assigned
- Aug 16, 2025
- 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 | 64068 | OR | Primary |
Addresses
Primary practice location
402 SE G St
Grants Pass, OR 97526-3066
Mailing address
650 N Haskell St
Central Point, OR 97502-2592
Phone (707) 396-2759
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 |
|---|---|---|---|
| 64068 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755302400000",
"number": "1538046222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 N HASKELL ST",
"city": "CENTRAL POINT",
"state": "OR",
"postal_code": "975022592",
"telephone_number": "707-396-2759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 SE G ST",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975263066",
"telephone_number": "541-476-1583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAPANICOLAS",
"first_name": "JACOB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-16",
"last_updated": "2025-08-16",
"certification_date": "2025-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "64068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.