Provider Demographics
NPI:1538964788
Name:FORD, JACOB MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MICHAEL
Last Name:FORD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18878 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3504
Mailing Address - Country:US
Mailing Address - Phone:303-418-4450
Mailing Address - Fax:303-418-4653
Practice Address - Street 1:18878 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3504
Practice Address - Country:US
Practice Address - Phone:303-418-4450
Practice Address - Fax:303-418-4653
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist