Provider Demographics
NPI:1912613431
Name:SYTSMA, JACOB A (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:A
Last Name:SYTSMA
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 1:1325 UTICA AVE S APT 428
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4596
Mailing Address - Country:US
Mailing Address - Phone:708-308-7192
Mailing Address - Fax:
Practice Address - Street 1:930 BLUE GENTIAN RD STE 1000
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1675
Practice Address - Country:US
Practice Address - Phone:651-683-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist