Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Dickerson

Individual provider Physical Therapist · NPI 1730853292

Jacob Dickerson is a Physical Therapist in Private Practice in Louisville, Kentucky. Qualified in 2021, 5 years ago. Practices with Omspt Holdings LLC, a 12-clinician group and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
5
Licensed in
KY
In the registry since
2021
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Practice location Partly verified

Some contact details are missing from the federal record.

6008 Brownsboro Park Blvd
Louisville, KY 40207-1295
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 008310 (KY)

Record details

NPI number1730853292
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 6, 2021
Last updated in NPPESAugust 6, 2021
Certification dateAugust 6, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Omspt Holdings Llc — 12 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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