Healthcare Provider Details

I. General information

NPI: 1427371665
Provider Name (Legal Business Name): DAE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W BURLINGTON AVE STE 200
FAIRFIELD IA
52556-3243
US

IV. Provider business mailing address

11623 ARBOR ST
OMAHA NE
68144-2981
US

V. Phone/Fax

Practice location:
  • Phone: 641-469-3130
  • Fax: 641-243-4884
Mailing address:
  • Phone: 402-334-1919
  • Fax: 402-334-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: THERESA LYNN GODFREY
Title or Position: CLINIC ADMIN DIRECTOR
Credential:
Phone: 402-334-6025