Samantha Rose Jacoby, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

305 S Clark St
Mayville, WI 53050-1488

Phone

(920) 387-0354

NPI assigned

Mar 13, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520899200000",
    "number": "1780187088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5580 JACQUELINE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S CLARK ST",
            "city": "MAYVILLE",
            "state": "WI",
            "postal_code": "530501488",
            "telephone_number": "920-387-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "SAMANTHA",
        "middle_name": "ROSE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-13",
        "last_updated": "2018-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James John Herget, DDS
• Herman School District 22
• Ashley Nicole Hettich, PT, DPT
• Cassandre Bezold Hetzer, O.D.
• Horicon Street Chiropractic, S.C.
• Cyndi L Jurgensen, DC
• Angela N Katzfuss, PHARMD
• Marci D. Kessen, M.D.
• Alisha L Ketterer, MD
• Delaney King

• Physical Therapy Assistant in Mayville, WI
• Providers in Mayville, WI by specialty
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; 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.