Healthcare Provider Details

I. General information

NPI: 1154706273
Provider Name (Legal Business Name): TREVOR FRANCK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 JACOLYN DR SW
CEDAR RAPIDS IA
52404-1288
US

IV. Provider business mailing address

2401 TOWNCREST DR
IOWA CITY IA
52240-6631
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-0222
  • Fax: 319-396-1525
Mailing address:
  • Phone: 319-354-2429
  • Fax: 319-354-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number078158
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0665463
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: