Healthcare Provider Details

I. General information

NPI: 1124404272
Provider Name (Legal Business Name): VIVE IV THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7407 THUNDER VALLEY DR
PEOSTA IA
52068-9475
US

IV. Provider business mailing address

7407 THUNDER VALLEY DR
PEOSTA IA
52068-9475
US

V. Phone/Fax

Practice location:
  • Phone: 563-284-2422
  • Fax: 563-200-7747
Mailing address:
  • Phone: 563-284-2422
  • Fax: 563-200-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA122623
License Number StateIA

VIII. Authorized Official

Name: STEPHANIE GRUTZ
Title or Position: CEO - OWNER
Credential: ARNP, FNP-C
Phone: 563-284-2422