Healthcare Provider Details

I. General information

NPI: 1598678765
Provider Name (Legal Business Name): SETH MICHEAL EDENS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S MAIN ST
FAIRFIELD IA
52556-3793
US

IV. Provider business mailing address

826 COUNTRY LANE RD
KEOSAUQUA IA
52565-1001
US

V. Phone/Fax

Practice location:
  • Phone: 641-472-4111
  • Fax:
Mailing address:
  • Phone: 563-357-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number137216
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: