MEDICARE: JACOB LINCOLN STEARNS DPT

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
1	225100000X	Physical Therapist	109492	IA

General Provider Information

NPI Number	:	1306518840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB LINCOLN STEARNS DPT

Provider Business Mailing Address
First Line	:	850 43RD AVE STE 100
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-8401
Country	:	US
Telephone Number	:	309-743-2070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 NE STATION XING STE 105
Second Line	:
City	:	GRIMES
State	:	IA
Zip	:	50111-8013
Country	:	US
Telephone Number	:	515-984-0075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	06/03/2024

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