Active NPI
Richard Dean Jacobs, PT
- Physical Therapist
- Moose Lake, MN
National Provider Identifier
1851544290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2412
- Practice address
- 710 S Kenwood Ave
Moose Lake, MN 55767-9405 - Phone
- (218) 485-5634
- NPI assigned
- Oct 29, 2008
- Last updated
- Oct 29, 2008
- 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 | 2412 | MN | Primary |
Addresses
Primary practice location
710 S Kenwood Ave
Moose Lake, MN 55767-9405
Mailing address
710 S Kenwood Ave
Moose Lake, MN 55767-9405
Phone (218) 485-5634
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225238400000",
"number": "1851544290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 S KENWOOD AVE",
"city": "MOOSE LAKE",
"state": "MN",
"postal_code": "557679405",
"telephone_number": "218-485-5634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 S KENWOOD AVE",
"city": "MOOSE LAKE",
"state": "MN",
"postal_code": "557679405",
"telephone_number": "218-485-5634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "RICHARD",
"middle_name": "DEAN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-29",
"last_updated": "2008-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "2412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moose Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.