1780966614 NPI number — ROCK VALLEY PHYSICAL THERAPY CENTER

Table of content: (NPI 1780966614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780966614 NPI number — ROCK VALLEY PHYSICAL THERAPY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCK VALLEY PHYSICAL THERAPY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780966614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 43RD AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-8401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-743-2070
Provider Business Mailing Address Fax Number:
309-743-2073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2635 LINCOLN WAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52732-7203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-243-8321
Provider Business Practice Location Address Fax Number:
563-241-4353
Provider Enumeration Date:
09/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BOLDT
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
309-743-2070

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0565937 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: I1844 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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