Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 1508 | SD |
N | 2251S0007X | Physical Therapist - Sports | 1508 | SD |
Y | 2251X0800X | Physical Therapist - Orthopedic | 1508 | SD |
NPI | 1487949178 |
---|---|
Provider Name | Jacob Tesch |
First Address | Watertown, SD 57201-9600 |
Second Address | Watertown, SD 57201-9600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 21/05/2013 |