Healthcare Provider Details

I. General information

NPI: 1528338076
Provider Name (Legal Business Name): CAROL TUTHILL DALY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAWKINS DR
IOWA CITY IA
52242-1016
US

IV. Provider business mailing address

1085 YELLOW PINE AVE NE
LISBON IA
52253-9511
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-1435
  • Fax:
Mailing address:
  • Phone: 319-455-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00951
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014835
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: