Healthcare Provider Details

I. General information

NPI: 1689580532
Provider Name (Legal Business Name): TREY WODKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5264 COUNCIL ST NE
CEDAR RAPIDS IA
52402-2471
US

IV. Provider business mailing address

3215 29TH AVE SW
CEDAR RAPIDS IA
52404-3805
US

V. Phone/Fax

Practice location:
  • Phone: 319-693-1171
  • Fax:
Mailing address:
  • Phone: 319-693-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: