MEDICARE: KELLIE SAUTER 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	225100000X	Physical Therapist	004048	IA

General Provider Information

NPI Number	:	1790199925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE SAUTER DPT

Provider Business Mailing Address
First Line	:	4725 MERLE HAY RD
Second Line	:	SUITE 107
City	:	DES MOINES
State	:	IA
Zip	:	50322-1983
Country	:	US
Telephone Number	:	515-331-3190
Fax Number	:	515-331-3191

Provider Business Practice Location Address
First Line	:	1220 5TH AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-4049
Country	:	US
Telephone Number	:	319-366-8701
Fax Number	:	319-896-4342

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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