Individual provider Active NPI

Jacob Christian Harle, DPT, ATC

  • Physical Therapist
  • Saint Paul, MN
National Provider Identifier
1740779057
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
109035 Issued in IA
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

Updated by the provider on Nov 14, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231012001594 WA Practitioner - Physical Therapist in Private Practice 0840645719 Reassigns benefits to 1 organization
I20240229000214 MN Practitioner - Physical Therapist in Private Practice 0840645719 Reassigns benefits to 1 organization

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
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

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

LicenseStateTypeSpecialty
109035IAMDPhysical Therapist
13311MNMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Nov 11, 2024 Accepting new patients
Multicare Health System CurrentSince Aug 24, 2023 Accepting new patients
Multicare Health System Current Accepting new patients
Infinite Health Collaborative, PA Physical Therapist CurrentSince Nov 11, 2024 Accepting new patients
Multicare Health System CurrentSince Aug 24, 2023 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.

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.

Verify at the official NPI Registry.