Active NPI
Michael Jacob, PT
- Physical Therapist
- Kahului, HI
National Provider Identifier
1841374253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 858
- Practice address
- 430 Kele St
Ste 401
Kahului, HI 96732-3406 - Phone
- (808) 871-0900
- Fax
- (808) 871-9119
- NPI assigned
- Oct 24, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 858 | HI | Primary |
Addresses
Primary practice location
430 Kele St
Ste 401
Kahului, HI 96732-3406
Mailing address
53 N. Puunene Ave
Suite 104
Kahului, HI 96732
Phone (808) 871-0900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05710007 | Medicaid | HI |
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 |
|---|---|---|---|
| 858 | HI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524528000000",
"number": "1841374253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "53 N. PUUNENE AVE",
"address_2": "SUITE 104",
"city": "KAHULUI",
"state": "HI",
"postal_code": "96732",
"telephone_number": "808-871-0900",
"fax_number": "808-871-9119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 KELE ST",
"address_2": "STE 401",
"city": "KAHULUI",
"state": "HI",
"postal_code": "967323406",
"telephone_number": "808-871-0900",
"fax_number": "808-871-9119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "MICHAEL",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2018-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "HI",
"license": "858",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05710007",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kahului, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.