Active NPI
Jacob E. Blaine, MS, PT
- Physical Therapist
- Ithaca, NY
National Provider Identifier
1649422155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 022013-1
- Practice address
- 1001 W Seneca St
Ithaca, NY 14850-3342 - Phone
- (607) 277-8020
- Fax
- (607) 277-7961
- NPI assigned
- Oct 15, 2008
- 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 | 022013-1 | NY | Primary |
Addresses
Primary practice location
1001 W Seneca St
Ithaca, NY 14850-3342
Mailing address
1001 W Seneca St
Ithaca, NY 14850-3342
Phone (607) 277-8020
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022013-1 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Educational Based Services | 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 and National Provider Directory roles.
-
- Early Intervention Provider Agency
- West Chester, PA
- NPI 1326092602
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224028800000",
"number": "1649422155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 W SENECA ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148503342",
"telephone_number": "607-277-8020",
"fax_number": "607-277-7961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W SENECA ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148503342",
"telephone_number": "607-277-8020",
"fax_number": "607-277-7961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAINE",
"first_name": "JACOB",
"middle_name": "E.",
"credential": "MS, PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-15",
"last_updated": "2008-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "022013-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.