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

Jacob Kelso, DPT

Individual provider Orthopedic Physical Therapist · NPI 1518472059

Jacob Kelso, DPT is a Physical Therapist in Private Practice in Mesa, Arizona. Qualified in 2017, 9 years ago. Practices with Modern Sports Medicine LLC, a 40-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
9
Licensed in
AZ
In the registry since
2017
Specialties on file
2
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

2835 E Brown Rd Ste 101
Mesa, AZ 85213-5470
Phone: (480) 807-6644
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5590 W Chandler Blvd, Chandler, AZ 85226-3740 — (480) 786-4969

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 13450 (AZ)
Orthopedic Physical Therapist Taxonomy 2251X0800X

Record details

NPI number1518472059
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedDecember 6, 2017
Last updated in NPPESApril 9, 2021
Certification dateApril 9, 2021
Mailing address2835 E Brown Rd Ste 101, Mesa, AZ 85213-5470

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Modern Sports Medicine Llc — 40 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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