1821480302 NPI number — IOWA PHYSICAL THERAPY, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821480302 NPI number — IOWA PHYSICAL THERAPY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA PHYSICAL THERAPY, P.C.
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:
CEDAR HAND 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:
1821480302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 1ST AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52314-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-895-4085
Provider Business Mailing Address Fax Number:
319-895-8013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2750 1ST AVE NE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-366-1886
Provider Business Practice Location Address Fax Number:
319-366-1611
Provider Enumeration Date:
02/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MARGHEIM
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
319-895-4085

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  6178650001 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0477679 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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