MEDICARE: JACOB PAWOL PT, DPT, OCS

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	095370	IA

General Provider Information

NPI Number	:	1558716027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB PAWOL PT, DPT, OCS

Provider Business Mailing Address
First Line	:	1040 SE FRONTIER AVE UNIT 120
Second Line	:
City	:	WAUKEE
State	:	IA
Zip	:	50263-8969
Country	:	US
Telephone Number	:	515-216-0847
Fax Number	:	515-724-7270

Provider Business Practice Location Address
First Line	:	1040 SE FRONTIER AVE UNIT 120
Second Line	:
City	:	WAUKEE
State	:	IA
Zip	:	50263-8969
Country	:	US
Telephone Number	:	515-216-0847
Fax Number	:	515-724-7270

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

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	03/18/2026

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