MEDICARE: JACOB E TODD PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-7512	ID
2	225100000X	Physical Therapist	14353	MN

General Provider Information

NPI Number	:	1568138576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB E TODD PT, DPT

Provider Business Mailing Address
First Line	:	1939 MINNEHAHA AVE W STE 300
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1033
Country	:	US
Telephone Number	:	651-748-4338
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 CENTRAL AVE W STE 102
Second Line	:
City	:	SAINT MICHAEL
State	:	MN
Zip	:	55376-9711
Country	:	US
Telephone Number	:	763-595-1300
Fax Number	:	763-276-1190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	05/21/2026

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