Healthcare Provider Details

I. General information

NPI: 1780687939
Provider Name (Legal Business Name): AGAPE THERAPY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 6TH ST
CEDAR FALLS IA
50613-2859
US

IV. Provider business mailing address

211 W 6TH ST
CEDAR FALLS IA
50613-2859
US

V. Phone/Fax

Practice location:
  • Phone: 319-277-3166
  • Fax: 319-266-4846
Mailing address:
  • Phone: 319-277-3166
  • Fax: 319-266-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. JOAN TRUEX
Title or Position: BUSINESS MANAGER
Credential:
Phone: 319-277-3166