MEDICARE: JACOB JUDSON MORSE 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	PT44217	FL
2	225100000X	Physical Therapist	5501018056	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5501018056	OTHER	MI	MEDICAL LICENSE

General Provider Information

NPI Number	:	1578009544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB JUDSON MORSE DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 DANIELS PKWY STE 36
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-1587
Country	:	US
Telephone Number	:	239-936-4404
Fax Number	:	239-936-5156

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

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	01/05/2026

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