Active NPI
Jacob Stryker, PT, DPT, ATC
- Physical Therapist
- Shenandoah, IA
National Provider Identifier
1821487752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4284
- Practice address
- 300 Pershing Ave
Shenandoah, IA 51601-2355 - Phone
- (712) 246-7007
- NPI assigned
- Jan 15, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 078769 | IA | |
| Physical Therapist | 225100000X | 4284 | NE | Primary |
| Athletic Trainer | 2255A2300X | 729 | NE |
Addresses
Primary practice location
300 Pershing Ave
Shenandoah, IA 51601-2355
Mailing address
933 E Pierce St
Council Bluffs, IA 51503-4626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4284 | NE | MD | Physical Therapist |
| 078769 | IA | MD | Athletic Trainer |
| 729 | NE | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631836800000",
"number": "1821487752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "933 E PIERCE ST",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515034626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PERSHING AVE",
"city": "SHENANDOAH",
"state": "IA",
"postal_code": "516012355",
"telephone_number": "712-246-7007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STRYKER",
"first_name": "JACOB",
"credential": "PT, DPT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-15",
"last_updated": "2021-09-17",
"certification_date": "2021-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IA",
"license": "078769",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NE",
"license": "4284",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NE",
"license": "729",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shenandoah, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.