Healthcare Provider Details

I. General information

NPI: 1942773981
Provider Name (Legal Business Name): JACOB R DYBDAHL PT, DPT, FAAOMPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 3RD ST W BLDG 1040
JBSA RANDOLPH TX
78150-4800
US

IV. Provider business mailing address

221 3RD ST W BLDG 1040
JBSA RANDOLPH TX
78150-4800
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-3137
  • Fax:
Mailing address:
  • Phone: 210-652-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1309201
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: