Healthcare Provider Details

I. General information

NPI: 1801469176
Provider Name (Legal Business Name): TRAVIS JOSEPH SIWIEC DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 DALTON WAY SW SUITE 400
CEDAR RAPIDS IA
52404
US

IV. Provider business mailing address

3500 DALTON WAY SW
CEDAR RAPIDS IA
52404-2564
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-4340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number106735
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: