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

Jacob Johnson

Individual provider Physical Therapy Assistant · NPI 1164310926

Jacob Johnson is a Physical Therapy Assistant in Oak Creek, Wisconsin. Practices as a sole proprietor. Licensed in Wisconsin.

Licensed in
WI
In the registry since
2025

Practice location Address checks out

2700 W Honadel Blvd
Oak Creek, WI 53154-2650
Phone: (414) 420-2919
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 3213-19 (WI)

Record details

NPI number1164310926
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 27, 2025
Last updated in NPPESJune 27, 2025
Certification dateJune 27, 2025
Mailing address2123 27th St, Kenosha, WI 53140-5011

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