Healthcare Provider Details

I. General information

NPI: 1922490630
Provider Name (Legal Business Name): JENNA MORIO D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 3RD AVE SW SUITE 102
CEDAR RAPIDS IA
52404-5736
US

IV. Provider business mailing address

101 3RD AVE SW SUITE 102
CEDAR RAPIDS IA
52404-5736
US

V. Phone/Fax

Practice location:
  • Phone: 319-200-6102
  • Fax: 319-200-6104
Mailing address:
  • Phone: 319-200-6102
  • Fax: 319-200-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number075994
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: