Active NPI
Lea Renae Jacobson, MPT
- Physical Therapist
- Poulsbo, WA
National Provider Identifier
1619052826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 00010056
- Practice address
- 1015 NE Hostmark St
Suite 101
Poulsbo, WA 98370 - Phone
- (360) 697-7726
- Fax
- (360) 677-7728
- NPI assigned
- Oct 26, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 | 00010056 | WA | Primary |
Addresses
Primary practice location
1015 NE Hostmark St
Suite 101
Poulsbo, WA 98370
Mailing address
9621 Ridgetop Blvd
Suite 100
Silverdale, WA 98383
Phone (360) 337-7662
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
| License | State | Type | Specialty |
|---|---|---|---|
| 00010056 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sampson Enterprises Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619052826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9621 RIDGETOP BLVD",
"address_2": "SUITE 100",
"city": "SILVERDALE",
"state": "WA",
"postal_code": "98383",
"telephone_number": "360-337-7662",
"fax_number": "360-337-7300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 NE HOSTMARK ST",
"address_2": "SUITE 101",
"city": "POULSBO",
"state": "WA",
"postal_code": "98370",
"telephone_number": "360-697-7726",
"fax_number": "360-677-7728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "LEA",
"middle_name": "RENAE",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "00010056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poulsbo, WA
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.