Provider Demographics
NPI:1720168701
Name:VANELSWYK, JACOB ALAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ALAN
Last Name:VANELSWYK
Suffix:
Gender:M
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 1:4300 MARKET POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5423
Mailing Address - Country:US
Mailing Address - Phone:952-769-1684
Mailing Address - Fax:
Practice Address - Street 1:4300 MARKET POINTE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5423
Practice Address - Country:US
Practice Address - Phone:952-769-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050255496225100000X
NY031102-1225100000X
MN7910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist