Jim Jacob, PT
Individual provider Active NPI Physical Therapist · Plymouth, IN
NPI 1790767887 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1790767887
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 05008652A (IN)
- Practice address
- 900 W Jefferson St
Plymouth, IN 46563-1634 - Phone
- (574) 936-9600
- Fax
- (574) 936-9612
- NPI assigned
- Nov 15, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05008652A | IN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apex Therapy Services, LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008652A | IN | Yes |
Addresses
Primary practice location
900 W Jefferson St
Plymouth, IN 46563-1634
Mailing address
PO Box 308
Mishawaka, IN 46546-0308
Phone (574) 273-6546
Other providers in Plymouth, IN
- Keshena Marie Hunter
- Muhammad M Hussain
- Indiana Hearing LLC
- Nkemakolam Iroegbu
- Jada Jackson
- Seema Jain
- Jeas Hunter LLC
- Jeffrey Sheedy DO LLC
- Erica Jesuit
- Johnson Memorial Hospital
All providers in Plymouth, IN · Physical Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.