Healthcare Provider Details

I. General information

NPI: 1578703831
Provider Name (Legal Business Name): TRICIA REMBOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W CENTRAL AVE
ESTHERVILLE IA
51334-1834
US

IV. Provider business mailing address

508 W CENTRAL AVE
ESTHERVILLE IA
51334-1834
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-7715
  • Fax: 712-362-7716
Mailing address:
  • Phone: 712-362-7715
  • Fax: 712-362-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number004811
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: