MEDICARE: JACOB RAYMOND HARDY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	115490	IA

General Provider Information

NPI Number	:	1538872080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB RAYMOND HARDY DPT

Provider Business Mailing Address
First Line	:	803 COTTAGE ST
Second Line	:
City	:	ADEL
State	:	IA
Zip	:	50003-2033
Country	:	US
Telephone Number	:	515-993-5599
Fax Number	:	515-993-1964

Provider Business Practice Location Address
First Line	:	803 COTTAGE ST
Second Line	:
City	:	ADEL
State	:	IA
Zip	:	50003-2033
Country	:	US
Telephone Number	:	515-993-5599
Fax Number	:	515-993-1964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	12/29/2022

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