MEDICARE: MARIAH JIMMERSON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	126870	IA

General Provider Information

NPI Number	:	1033949110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH JIMMERSON PT, DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 S MADISON ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3841
Country	:	US
Telephone Number	:	319-248-0373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	03/11/2026

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