Healthcare Provider Details

I. General information

NPI: 1972590370
Provider Name (Legal Business Name): WILLIAM A FELLOWS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314-1548
US

IV. Provider business mailing address

1801 HICKMAN RD
DES MOINES IA
50314-1597
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-5621
  • Fax: 515-282-3618
Mailing address:
  • Phone: 515-282-5621
  • Fax: 515-282-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01214
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number01214
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: