MEDICARE: FORTITUDE & FREEDOM, PLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1831851781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTITUDE & FREEDOM, PLC

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	:	OWNER/PHYSICAL THERAPIST
Name	:	JACOB PAWOL
Credential	:	PT, DPT, OCS
Telephone Number	:	515-216-0847

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	03/18/2026

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