Healthcare Provider Details

I. General information

NPI: 1346313996
Provider Name (Legal Business Name): SIOUX CITY PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 CASTLES GATE DR
SIOUX CITY IA
51106-7203
US

IV. Provider business mailing address

2802 CASTLES GATE DR
SIOUX CITY IA
51106-7203
US

V. Phone/Fax

Practice location:
  • Phone: 712-266-0707
  • Fax: 712-266-0709
Mailing address:
  • Phone: 712-266-0707
  • Fax: 712-266-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN LEO VENNE
Title or Position: OWNER
Credential: P.T.
Phone: 712-266-0707