Healthcare Provider Details

I. General information

NPI: 1932737004
Provider Name (Legal Business Name): JOHN URBAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 MERLE HAY RD STE 200
DES MOINES IA
50310-1357
US

IV. Provider business mailing address

4020 MERLE HAY RD STE 200
DES MOINES IA
50310-1357
US

V. Phone/Fax

Practice location:
  • Phone: 515-278-8444
  • Fax: 515-278-6723
Mailing address:
  • Phone: 515-278-8444
  • Fax: 515-278-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: