Provider Demographics
NPI:1205366879
Name:KRINGLE, JACOB NO (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:NO
Last Name:KRINGLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2213
Mailing Address - Country:US
Mailing Address - Phone:308-872-5111
Mailing Address - Fax:308-872-5115
Practice Address - Street 1:3811 CENTRAL AVE STE F
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8173
Practice Address - Country:US
Practice Address - Phone:308-237-0591
Practice Address - Fax:308-237-4251
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist