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NPI Code Detail

MEDICARE: JARED DAVID BROSTAD P.T.

MEDICARE: JARED DAVID BROSTAD P.T.
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
1225100000XPhysical Therapist03540IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1I7658OTHERIAMEDICARE GROUP

General Provider Information

NPI Number : 1831181890
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED DAVID BROSTAD P.T.
Provider Business Mailing Address
First Line : 450 LAUREL ST STE A
Second Line :
City : DES MOINES
State : IA
Zip : 50314-3045
Country : US
Telephone Number : 515-247-8400
Fax Number : 515-248-8888
Provider Business Practice Location Address
First Line : 450 LAUREL ST STE A
Second Line :
City : DES MOINES
State : IA
Zip : 50314-3045
Country : US
Telephone Number : 515-247-8400
Fax Number : 515-248-8888
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 01/10/2025

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Directions to “ JARED DAVID BROSTAD P.T.” Practice Location

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