Healthcare Provider Details

I. General information

NPI: 1982448205
Provider Name (Legal Business Name): JOHN EIKENBERRY PT, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N 9TH AVE
VINTON IA
52349-2254
US

IV. Provider business mailing address

502 N 9TH AVE
VINTON IA
52349-2254
US

V. Phone/Fax

Practice location:
  • Phone: 319-472-6372
  • Fax:
Mailing address:
  • Phone: 319-472-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03539
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00504
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: