Healthcare Provider Details

I. General information

NPI: 1649156779
Provider Name (Legal Business Name): JACOB NELSON WESSELINK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

5300 BROOKVIEW DR
WEST DES MOINES IA
50266-6366
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6907
  • Fax:
Mailing address:
  • Phone: 515-689-3708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number106437
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number106437
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: