Healthcare Provider Details

I. General information

NPI: 1700986304
Provider Name (Legal Business Name): TOTAL REHAB-ORTHOPEDIC AND SPORTS SPECIALIST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WEST ST S SOUTHVIEW PLAZA SUITE #4
GRINNELL IA
50112-8160
US

IV. Provider business mailing address

234 WEST ST S SOUTHVIEW PLAZA SUITE #4
GRINNELL IA
50112-8160
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-4506
  • Fax: 641-236-4316
Mailing address:
  • Phone: 641-236-4506
  • Fax: 641-236-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3382
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number04029
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004152
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1432
License Number StateIA

VIII. Authorized Official

Name: MRS. STACEY A ALBERTS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 641-236-4506