Provider Demographics
NPI:1851926729
Name:PSZANKA, JACOB DANIEL (ATC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:PSZANKA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 FREDRICK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMONS
Mailing Address - State:IA
Mailing Address - Zip Code:50051-9637
Mailing Address - Country:US
Mailing Address - Phone:641-485-5654
Mailing Address - Fax:
Practice Address - Street 1:203 WELLNESS AND RECREATION CENTER
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0001
Practice Address - Country:US
Practice Address - Phone:319-273-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0929732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer