Healthcare Provider Details

I. General information

NPI: 1851254205
Provider Name (Legal Business Name): LINCOLN KLEESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W BRIDGE RD STE A
POLK CITY IA
50226-2308
US

IV. Provider business mailing address

850 43RD AVE STE 100
MOLINE IL
61265-8401
US

V. Phone/Fax

Practice location:
  • Phone: 515-984-6377
  • Fax:
Mailing address:
  • Phone: 309-743-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: