Healthcare Provider Details

I. General information

NPI: 1528224664
Provider Name (Legal Business Name): PHYSICAL MEDICINE & REHABILITATION ASSOCIATES OF NORTHEAST IOWA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 03/09/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5036
US

IV. Provider business mailing address

PO BOX 238
WATERLOO IA
50704-0238
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7211
  • Fax:
Mailing address:
  • Phone: 319-234-0109
  • Fax: 319-234-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number27493
License Number StateIA

VII. Legacy identifiers

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

# 1
IdentifierIB1110
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerMEDICARE GROUP IB1110

VIII. Authorized Official

Name: DR. FARID FREDERIK MANSHASI
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 319-234-0109