Provider Demographics
NPI:1285975078
Name:WENDLAND, JACOB ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ALLEN
Last Name:WENDLAND
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:410 30TH AVE E STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4770
Mailing Address - Country:US
Mailing Address - Phone:320-763-5505
Mailing Address - Fax:320-763-4447
Practice Address - Street 1:1304 W LINCOLN AVE STE C
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-4818
Practice Address - Country:US
Practice Address - Phone:218-998-0701
Practice Address - Fax:218-998-2425
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN88332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic