1568465789 NPI number — JOHN T. VOYLES AND OR HEATHER K. VOYLES

Table of content: (NPI 1568465789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568465789 NPI number — JOHN T. VOYLES AND OR HEATHER K. VOYLES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN T. VOYLES AND OR HEATHER K. VOYLES
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:
SOUTH EAST IOWA PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1568465789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SOUTH EAST IOWA PHYSICAL THERAPY
Provider Second Line Business Mailing Address:
115 S WASHINGTON ST
Provider Business Mailing Address City Name:
OTTUMWA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52501-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-682-8171
Provider Business Mailing Address Fax Number:
641-682-9054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOUTH EAST IOWA PHYSICAL THERAPY
Provider Second Line Business Practice Location Address:
115 S WASHINGTON ST
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-682-8171
Provider Business Practice Location Address Fax Number:
641-682-9054
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VOYLES
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
KATHLEEN
Authorized Official Title or Position:
OWNER AND P.T.
Authorized Official Telephone Number:
641-682-8171

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  02109 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 02520 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 02125 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 02941 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 04012 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 078601 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 00279 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 00376 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 001368 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0665349 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6-6534 . This is a "BCBS GROUP PROVIDER NUMBE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".