Healthcare Provider Details

I. General information

NPI: 1578020780
Provider Name (Legal Business Name): COURTNEY RALFS PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 03/08/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 D AVE
KALONA IA
52247-9592
US

IV. Provider business mailing address

3290 RIDGEWAY DR STE 3
CORALVILLE IA
52241-2023
US

V. Phone/Fax

Practice location:
  • Phone: 319-656-2630
  • Fax: 319-656-4409
Mailing address:
  • Phone: 319-665-2630
  • Fax: 319-665-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number111215
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number097072
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: