Provider Demographics
NPI:1861917742
Name:ERBES, JACOB LONNIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:LONNIE
Last Name:ERBES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17067 COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:ND
Mailing Address - Zip Code:58018-9637
Mailing Address - Country:US
Mailing Address - Phone:701-640-3381
Mailing Address - Fax:
Practice Address - Street 1:430 5TH ST N
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1426
Practice Address - Country:US
Practice Address - Phone:218-641-7725
Practice Address - Fax:218-641-6625
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10816225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1472442Medicaid