Healthcare Provider Details

I. General information

NPI: 1497741896
Provider Name (Legal Business Name): ROBERT C WIEDERIEN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NEWTON RD 1-256 MEDICAL EDUCATION BUILDING
IOWA CITY IA
52242-5224
US

IV. Provider business mailing address

34 CHAD CT
CORALVILLE IA
52241-3228
US

V. Phone/Fax

Practice location:
  • Phone: 808-295-3309
  • Fax:
Mailing address:
  • Phone: 808-295-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: