Provider Demographics
NPI:1265595771
Name:NESPOR, JIM (PT)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:NESPOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATHLETIC DEPARTMENT
Mailing Address - Street 2:132 REC ATH FAC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50011-1330
Mailing Address - Country:US
Mailing Address - Phone:515-294-2626
Mailing Address - Fax:515-294-2794
Practice Address - Street 1:ATHLETIC DEPARTMENT
Practice Address - Street 2:132 REC ATH FAC
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-1330
Practice Address - Country:US
Practice Address - Phone:515-294-2626
Practice Address - Fax:515-294-2794
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45756OtherBCBS
IA0239400Medicaid
IA45756OtherBCBS