Jonathan Virgil Jacobsen, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

53121142401 Issued in UT

Practice address

680 E Main St Ste 101
Lehi, UT 84043-2251

Phone

(801) 768-2723

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Professional Physical Therapy and Sports MedicineGroup PAC ID 3173555281, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Professional Physical Therapy and Sports Medicine

  • Physical Therapist
  • Lehi, UT
  • NPI 1255440442
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619027836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 N 1300 E",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840439009",
            "telephone_number": "801-766-3729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 E MAIN ST STE 101",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840432251",
            "telephone_number": "801-768-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "JONATHAN",
        "middle_name": "VIRGIL",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "53121142401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ironwood Capital Group LLC
• Ivory Ridge Pediatric Dentistry
• Carrie Michelle Jackman, PA-C
• Harmony Jackson
• Maya Jackson
• Soren H. Jacobsen, DDS
• Kayla Jacobson, MDA, RDN, CD
• Maren Frances Jacobson, M.ED, BCBA
• April James
• Brooklyn Janes, DMD

• Physical Therapist in Lehi, UT
• Providers in Lehi, UT by specialty
• Physical Therapist in Utah

• 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.
• 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.