Provider Demographics
NPI:1952941734
Name:KAP, JACOB CARL (PT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CARL
Last Name:KAP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 S 2000 W STE 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9691
Mailing Address - Country:US
Mailing Address - Phone:801-896-9200
Mailing Address - Fax:801-896-1550
Practice Address - Street 1:5991 S 3500 W STE 300
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-6702
Practice Address - Country:US
Practice Address - Phone:801-985-2700
Practice Address - Fax:801-985-2707
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11589561-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist