Healthcare Provider Details

I. General information

NPI: 1609542117
Provider Name (Legal Business Name): ISAIAH VLASEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
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 Code225200000X
TaxonomyPhysical Therapy Assistant
License Number108290
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: