MEDICARE: JACOB KING 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	2026006433	MO

General Provider Information

NPI Number	:	1689536203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB KING DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 WINDING WOODS CTR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-4170
Country	:	US
Telephone Number	:	636-439-2004
Fax Number	:	636-439-2054

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	02/11/2026

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