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

Jacob Randolph Shattuck, PTA

Individual provider Physical Therapy Assistant · NPI 1881352516

Jacob Randolph Shattuck, PTA is a Physical Therapy Assistant in Rome, Georgia. Licensed in Georgia and Texas. Registered with an NPI since 2021.

Licensed in
GA, TX
In the registry since
2021
Specialties on file
2
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

600 Eagle Lake Trl
Rome, GA 30165-2207
Phone: (706) 368-9955
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence CP008628A (GA)
Physical Therapy Assistant Taxonomy 225200000X · Licence 2136779 (TX)

Record details

NPI number1881352516
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedNovember 30, 2021
Last updated in NPPESNovember 30, 2021
Certification dateNovember 12, 2021

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