Healthcare Provider Details

I. General information

NPI: 1215106661
Provider Name (Legal Business Name): ONEOTA PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 COLLEGE DR STE 4
DECORAH IA
52101-1342
US

IV. Provider business mailing address

308 COLLEGE DR STE 4
DECORAH IA
52101-1342
US

V. Phone/Fax

Practice location:
  • Phone: 563-382-1289
  • Fax: 563-382-4824
Mailing address:
  • Phone: 563-382-1289
  • Fax: 563-382-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number03817
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. TIMOTHY DUANE FECHNER
Title or Position: OWNER/DOCTOR OF PHYSICAL THERAPY
Credential: D.P.T.
Phone: 563-382-1289