Provider Demographics
NPI:1114663036
Name:JUSTESEN, JACOB HUNTER (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:HUNTER
Last Name:JUSTESEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:JAKE
Other - Middle Name:HUNTER
Other - Last Name:JUSTESEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1690 ASPEN CMNS APT 104
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4775
Mailing Address - Country:US
Mailing Address - Phone:715-218-3376
Mailing Address - Fax:
Practice Address - Street 1:1629 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-1571
Practice Address - Country:US
Practice Address - Phone:715-307-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist