Provider Demographics
NPI:1235425802
Name:IVERSON, JACLYN N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:N
Last Name:IVERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-3348
Mailing Address - Country:US
Mailing Address - Phone:605-725-9900
Mailing Address - Fax:605-725-9902
Practice Address - Street 1:6 N ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-3348
Practice Address - Country:US
Practice Address - Phone:605-725-9900
Practice Address - Fax:605-725-9902
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist