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NPI Code Detail

MEDICARE: JACOB BENNETT TINGOM PT, DPT

MEDICARE: JACOB BENNETT TINGOM 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
1225100000XPhysical TherapistP24733NC

General Provider Information

NPI Number : 1992597595
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB BENNETT TINGOM PT, DPT
Provider Business Mailing Address
First Line : 1429 BRYANT ST STE A
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-5201
Country : US
Telephone Number : 704-919-0867
Fax Number : 704-817-8579
Provider Business Practice Location Address
First Line : 9405 BRYANT FARMS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-1642
Country : US
Telephone Number : 908-207-2707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2025
Last Update Date : 02/11/2026

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