Jacob G Brueck, PT, DPT, ATC, CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

005080 Issued in IA

Practice address

710 E 1St St
Ankeny, IA 50021-2007

Phone

(515) 965-5311

Fax

(515) 965-5301

NPI assigned

Feb 7, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1821337031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 E 1ST ST",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500212007",
            "telephone_number": "515-965-5311",
            "fax_number": "515-965-5301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 E 1ST ST",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500212007",
            "telephone_number": "515-965-5311",
            "fax_number": "515-965-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUECK",
        "first_name": "JACOB",
        "middle_name": "G",
        "credential": "PT, DPT, ATC, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-07",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "005080",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1231180",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Brosnahan
• Jennifer Rye Brown, COTA/L
• Lori Miller Brown, RDH, MS
• Madison Alexandra Brown, MS, T-LMHC
• Quinlan Julia Brown
• Bruhl Medical
• Joseph Albert Brunkhorst III, D.O.
• Allison Bruns, PT, DPT
• Krysta Metz Bryars
• Shannon Bubnack, DPT

• Physical Therapist in Ankeny, IA
• Providers in Ankeny, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.