Provider Demographics
NPI:1487949178
Name:TESCH, JACOB (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:TESCH
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 1:913 10TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9600
Mailing Address - Country:US
Mailing Address - Phone:605-878-3334
Mailing Address - Fax:605-878-0245
Practice Address - Street 1:913 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9600
Practice Address - Country:US
Practice Address - Phone:605-878-3334
Practice Address - Fax:605-878-0245
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD15082251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports