Healthcare Provider Details

I. General information

NPI: 1467422014
Provider Name (Legal Business Name): SPORTSPLUS SPORTS MEDICINE AND PHYSICAL THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E MAIN ST
MARSHALLTOWN IA
50158-4903
US

IV. Provider business mailing address

32 E MAIN ST
MARSHALLTOWN IA
50158-4903
US

V. Phone/Fax

Practice location:
  • Phone: 641-753-6636
  • Fax: 641-753-1005
Mailing address:
  • Phone: 641-753-6636
  • Fax: 641-753-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN GONZALEZ
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 641-753-6636