Healthcare Provider Details

I. General information

NPI: 1376597708
Provider Name (Legal Business Name): MILLENNIUM REHAB & CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N 27TH ST
FORT DODGE IA
50501-4331
US

IV. Provider business mailing address

4725 MERLE HAY RD STE 207
DES MOINES IA
50322-1983
US

V. Phone/Fax

Practice location:
  • Phone: 515-955-6922
  • Fax:
Mailing address:
  • Phone: 515-331-3190
  • Fax: 515-331-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number00441
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02666
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02594
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03694
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028929
License Number StateIA
# 7
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00881
License Number StateIA
# 9
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01548
License Number StateIA
# 10
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01372
License Number StateIA
# 11
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01616
License Number StateIA
# 12
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00637
License Number StateIA
# 13
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01436
License Number StateIA

VIII. Authorized Official

Name: HOLLY LITTLE
Title or Position: COO
Credential:
Phone: 515-331-3190