MEDICARE: JODI L REYERSON D.P.T.

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	225100000X	Physical Therapist	01880	IA

General Provider Information

NPI Number	:	1083706923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI L REYERSON D.P.T.

Provider Business Mailing Address
First Line	:	5005 QUESADA AVE
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-7412
Country	:	US
Telephone Number	:	319-269-6839
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 QUESADA AVE
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-7412
Country	:	US
Telephone Number	:	319-269-6839
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	09/27/2010

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