Healthcare Provider Details

I. General information

NPI: 1497182653
Provider Name (Legal Business Name): EMILY ELIZABETH PUTNEY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E J ST STE 200
FOREST CITY IA
50436-1664
US

IV. Provider business mailing address

605 E J ST STE 200
FOREST CITY IA
50436-1664
US

V. Phone/Fax

Practice location:
  • Phone: 641-585-1550
  • Fax:
Mailing address:
  • Phone: 641-585-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001141
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: