Active NPI
Jacob Christian Harle, DPT, ATC
- Physical Therapist
- Saint Paul, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 109035
- Practice address
- 30 Fairview Ave S Ste 200
Saint Paul, MN 55105-1463 - Phone
- (952) 835-4512
- NPI assigned
- May 2, 2018
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 13311 | MN | |
| Athletic Trainer | 2255A2300X | |||
| Physical Therapist | 225100000X | 109035 | IA | Primary |
Addresses
Primary practice location
30 Fairview Ave S Ste 200
Saint Paul, MN 55105-1463
Mailing address
1039 Blair Ave
Saint Paul, MN 55104-2117
Phone (641) 512-4594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA, MN
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Des Moines University of Osteopathic Medicine and Health Sciences, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
30 Fairview Ave S
Suite 200
Saint Paul, MN 55105-1463
Phone (877) 609-0123
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109035 | IA | MD | Physical Therapist |
| 13311 | MN | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Infinite Health Collaborative, PA | Current | Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| Infinite Health Collaborative, PA | Physical Therapist | Current | Accepting new patients |
| Multicare Health System | Current | Accepting new patients | |
| St. Croix Orthopaedics, PA | Past | Accepting new patients |
Locations
920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155
30 Fairview Ave S
#200
Saint Paul, MN 55105
4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590
222 State Ave N
Kent, WA 98030
Phone (253) 372-7680
2405 N Pearl St
Ste 18
Tacoma, WA 98406
Phone (253) 503-1560
Organizations & group practices 6
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.
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Physical Therapist
-
- Neurological Surgery Physician
- Tacoma, WA
- NPI 1497766638
-
- Durable Medical Equipment & Medical Supplies
- Hudson, WI
- NPI 1568840916
-
- Family Medicine Physician
- Tacoma, WA
- NPI 1396297487
-
- Community/Retail Pharmacy
- Spokane, WA
- NPI 1396594875
-
- Specialist
- Oak Park Heights, MN
- NPI 1255337945
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731542400000",
"number": "1740779057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1039 BLAIR AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551042117",
"telephone_number": "641-512-4594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 FAIRVIEW AVE S STE 200",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551051463",
"telephone_number": "952-835-4512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARLE",
"first_name": "JACOB",
"middle_name": "CHRISTIAN",
"name_prefix": "Mr.",
"credential": "DPT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-02",
"last_updated": "2024-11-14",
"certification_date": "2024-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MN",
"license": "13311",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IA",
"license": "109035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; 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.