Provider Demographics
NPI:1275060204
Name:JANSMA, DOUG (PTA)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:JANSMA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLMAN
Mailing Address - State:IA
Mailing Address - Zip Code:52356-9232
Mailing Address - Country:US
Mailing Address - Phone:319-646-2911
Mailing Address - Fax:
Practice Address - Street 1:516 13TH ST
Practice Address - Street 2:
Practice Address - City:WELLMAN
Practice Address - State:IA
Practice Address - Zip Code:52356-9232
Practice Address - Country:US
Practice Address - Phone:319-646-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004832225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant