Healthcare Provider Details

I. General information

NPI: 1821487752
Provider Name (Legal Business Name): JACOB STRYKER PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PERSHING AVE
SHENANDOAH IA
51601-2355
US

IV. Provider business mailing address

933 E PIERCE ST
COUNCIL BLUFFS IA
51503-4626
US

V. Phone/Fax

Practice location:
  • Phone: 712-246-7007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4284
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number078769
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number729
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: