Provider Demographics
NPI:1013892496
Name:JAEGER, JACKSON (DPT)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:JAEGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2906
Mailing Address - Country:US
Mailing Address - Phone:563-580-2969
Mailing Address - Fax:
Practice Address - Street 1:107 S 11TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2245
Practice Address - Country:US
Practice Address - Phone:563-927-1499
Practice Address - Fax:563-927-1499
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA131219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist