Provider Demographics
NPI:1518531144
Name:KAMPS, JACOB (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KAMPS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12087 CHINOOK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2622
Mailing Address - Country:US
Mailing Address - Phone:360-630-8476
Mailing Address - Fax:
Practice Address - Street 1:1824 FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1729
Practice Address - Country:US
Practice Address - Phone:360-354-0585
Practice Address - Fax:360-354-1098
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61466277225100000X
AZ31798225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist