Individual provider Active NPI

Jacob Sobeck, PT, DPT

  • Physical Therapist
  • Wayland, MI
National Provider Identifier
1992589139
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501302770 Issued in MI
Practice address
709 W Superior St
Wayland, MI 49348-1226
Phone
(269) 792-4440
Fax
(616) 965-2475
NPI assigned
Aug 21, 2023
Last updated
Jun 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501302770 MI Primary

Addresses

Primary practice location

709 W Superior St
Wayland, MI 49348-1226

Mailing address

709 W Superior St
Wayland, MI 49348-1226
Phone (269) 792-4440

Other identifiers 1

IdentifierTypeStateIssuer
0C80917OtherMIBCBS

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

LicenseStateTypeSpecialty
5501302770MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Physical Therapy PC Physical Therapist Past Accepting new patients
Ivyrehab Northern PT, LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1992589139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W SUPERIOR ST",
            "city": "WAYLAND",
            "state": "MI",
            "postal_code": "493481226",
            "telephone_number": "269-792-4440",
            "fax_number": "616-965-2475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 W SUPERIOR ST",
            "city": "WAYLAND",
            "state": "MI",
            "postal_code": "493481226",
            "telephone_number": "269-792-4440",
            "fax_number": "616-965-2475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBECK",
        "first_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-21",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501302770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0C80917",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; 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.