Active NPI
Kyla Danelle Jacobo, DPT
- Physical Therapist
- Fresno, CA
National Provider Identifier
1821222019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 35010
- Practice address
- 1189 E Herndon Ave
Fresno, CA 93720-3167 - Phone
- (559) 259-0624
- NPI assigned
- May 4, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 35010 | CA | Primary |
Addresses
Primary practice location
1189 E Herndon Ave
Fresno, CA 93720-3167
Mailing address
4024 Trenton Ave
Clovis, CA 93619-5065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 35010 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241395200000",
"number": "1821222019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4024 TRENTON AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936195065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1189 E HERNDON AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937203167",
"telephone_number": "559-259-0624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBO",
"first_name": "KYLA",
"middle_name": "DANELLE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-04",
"last_updated": "2009-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 35010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.