Peter J Jacques, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3448-024 Issued in WI

Practice address

W4652 Glenn St
Appleton, WI 54913-9563

Phone

(920) 540-8840

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Peter John Jacques

  • Physical Therapist
  • Appleton, WI
  • NPI 1952597486
  NPD (past) Authorized official

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371168000000",
    "number": "1699717520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W4652 GLENN ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549139563",
            "telephone_number": "920-540-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W4652 GLENN ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549139563",
            "telephone_number": "920-540-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "PETER",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2013-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3448-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41750700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40299600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jabrille Unique Jackson
• Jade C Jackson, APNP-C
• Katie M Jackson, HEALTH COACH
• Kathryn M Jacobe, MD
• Jonathon Jacobs, LPC
• Tazeen H Jafar, MD
• Matthew G Jager, OT
• Pankaj Jain
• Karen Marie Jakubek
• Michael Jakubowski, MD

• Physical Therapist in Appleton, WI
• Providers in Appleton, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.