Healthcare Provider Details

I. General information

NPI: 1750766952
Provider Name (Legal Business Name): EASTERN IOWA THERAPEUTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 FOUNTAINS DR NE SUITE 106
CEDAR RAPIDS IA
52411-6607
US

IV. Provider business mailing address

5300 FOUNTAINS DR NE SUITE 106
CEDAR RAPIDS IA
52411-6607
US

V. Phone/Fax

Practice location:
  • Phone: 319-378-6958
  • Fax: 319-378-6938
Mailing address:
  • Phone: 319-378-6958
  • Fax: 319-378-6938

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: JUANA FERNANDEZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 630-575-1980