Healthcare Provider Details

I. General information

NPI: 1457779019
Provider Name (Legal Business Name): KEPROS PHYSICAL THERAPY AND PERFORMANCE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
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: 319-361-3546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. THEODORE JOHN KEPROS
Title or Position: OWNER
Credential: PT, MPT, MTC
Phone: 319-361-3546