Provider Demographics
NPI:1255568291
Name:NESSA, JACOB KEVIN (DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:KEVIN
Last Name:NESSA
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 1:789 HOLTON DR
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3757
Mailing Address - Country:US
Mailing Address - Phone:712-546-1718
Mailing Address - Fax:172-546-1770
Practice Address - Street 1:789 HOLTON DR
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3757
Practice Address - Country:US
Practice Address - Phone:712-546-1718
Practice Address - Fax:172-546-1770
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist