Provider Demographics
NPI:1891578886
Name:SCHUBERT, JACOB KENT (MED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:KENT
Last Name:SCHUBERT
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1999
Mailing Address - Country:US
Mailing Address - Phone:641-628-5453
Mailing Address - Fax:641-628-6065
Practice Address - Street 1:812 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1999
Practice Address - Country:US
Practice Address - Phone:641-628-5453
Practice Address - Fax:641-628-6065
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0012052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer