Individual provider Active NPI

Jacob E Todd, PT, DPT

  • Physical Therapist
  • Saint Michael, MN
National Provider Identifier
1568138576
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
14353 Issued in MN
Practice address
601 Central Ave W Ste 102
Saint Michael, MN 55376-9711
Phone
(763) 595-1300
Fax
(763) 276-1190
NPI assigned
Aug 19, 2021
Last updated
May 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-7512 ID
Physical Therapist 225100000X 14353 MN Primary

Addresses

Primary practice location

601 Central Ave W Ste 102
Saint Michael, MN 55376-9711

Mailing address

1939 Minnehaha Ave W Ste 300
Saint Paul, MN 55104-1033
Phone (651) 748-4338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250805001832 ID Practitioner - Physical Therapist in Private Practice 8921516444 Reassigns benefits to 1 organization
I20260601003316 MN Practitioner - Physical Therapist in Private Practice 8921516444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of North Dakota School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Land Rehabilitation LLCGroup PAC ID 9234048745, 207 clinicians
Therapy Partners IncGroup PAC ID 4486552593, 135 clinicians

Practice addresses (Care Compare)

1961 S Broadway Ave
Boise, ID 83706-4201
Phone (208) 422-9826

601 Central Ave W
Suite 102
Saint Michael, MN 55376-9711
Phone (763) 595-1300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT-7512IDMDPhysical Therapist
14353MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Land Rehabilitation LLC Physical Therapist CurrentSince May 23, 2025 Accepting new patients
Therapy Partners, Inc. Physical Therapist CurrentSince Jun 8, 2026 Accepting new patients
Therapy Partners Inc Physical Therapist PastSince Jun 8, 2026 Accepting new patients

Locations

1435 S Maple Grove Rd
Boise, ID 83709
Phone (208) 322-6200

1961 S Broadway Ave
Boise, ID 83706
Phone (208) 344-1851

1800 Flandro Dr
Ste 190
Pocatello, ID 83202
Phone (208) 233-2248

601 Central Ave W
Ste 102
Saint Michael, MN 55376
Phone (763) 595-1300

1939 Minnehaha Ave W
Ste 300
Saint Paul, MN 55104

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1568138576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1939 MINNEHAHA AVE W STE 300",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551041033",
            "telephone_number": "651-748-4338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CENTRAL AVE W STE 102",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553769711",
            "telephone_number": "763-595-1300",
            "fax_number": "763-276-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODD",
        "first_name": "JACOB",
        "middle_name": "E",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-7512",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "14353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Michael, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.