Healthcare Provider Details

I. General information

NPI: 1811360456
Provider Name (Legal Business Name): NILE PRICE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 09/25/2018
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

14168 OLD CASS RD
ANAMOSA IA
52205-7338
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-0222
  • Fax:
Mailing address:
  • Phone: 319-480-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003967
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number078483
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: