Healthcare Provider Details

I. General information

NPI: 1710650049
Provider Name (Legal Business Name): JACOB D DYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 UNIVERSITY AVE STE AND1116
WEST DES MOINES IA
50266-1888
US

IV. Provider business mailing address

9500 UNIVERSITY AVE STE AND1116
WEST DES MOINES IA
50266-1888
US

V. Phone/Fax

Practice location:
  • Phone: 515-987-9012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number109052
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: