Healthcare Provider Details

I. General information

NPI: 1124346507
Provider Name (Legal Business Name): DAVID L RUBSAM PT, OCS, ASTYM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 44TH ST SUITE 10,000
MARION IA
52302-3846
US

IV. Provider business mailing address

999 44TH ST SUITE 10,000
MARION IA
52302-3846
US

V. Phone/Fax

Practice location:
  • Phone: 319-373-7311
  • Fax: 319-373-7313
Mailing address:
  • Phone: 319-373-7311
  • Fax: 319-373-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1609
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number01609
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: