1861523326 NPI number — DUBUQUE PHYSICAL THERAPY P.C.

Table of content: (NPI 1861523326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861523326 NPI number — DUBUQUE PHYSICAL THERAPY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBUQUE 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:
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:
1861523326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4005 WESTMARK DR
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52002-2271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-588-3891
Provider Business Mailing Address Fax Number:
563-588-3893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4005 WESTMARK DR
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52002-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-588-3891
Provider Business Practice Location Address Fax Number:
563-588-3893
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
MELVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
563-588-3891

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  U3051 , 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: 25550 . This is a "GROUP BCBS NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1174699128 . This is a "NPI WILLIAM O'DELL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0129189 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1114972775 . This is a "NPI JASON PUTZ" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1669411922 . This is a "NPI MEL HARVEY" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750320016 . This is a "NPI JASON MEYER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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