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NPI Code Detail

MEDICARE: HOLLY BERTSCH PTA

MEDICARE: HOLLY BERTSCH PTA
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
1225200000XPhysical Therapy Assistant090699IA

General Provider Information

NPI Number : 1396371233
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY BERTSCH PTA
Provider Business Mailing Address
First Line : 6452 N ROCKY RD
Second Line :
City : EAST DUBUQUE
State : IL
Zip : 61025-9452
Country : US
Telephone Number : 563-580-9507
Fax Number :
Provider Business Practice Location Address
First Line : 6420 COUNCIL ST NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-1129
Country : US
Telephone Number : 319-393-1447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2020
Last Update Date : 03/22/2020

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Directions to “ HOLLY BERTSCH PTA” Practice Location

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