Healthcare Provider Details

I. General information

NPI: 1912987108
Provider Name (Legal Business Name): PHYSICAL THERAPY PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 TOWER PARK DR
WATERLOO IA
50701-9026
US

IV. Provider business mailing address

815 TOWER PARK DR
WATERLOO IA
50701-9026
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-6995
  • Fax: 319-233-7083
Mailing address:
  • Phone: 319-233-6995
  • Fax: 319-233-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02905
License Number StateIA

VIII. Authorized Official

Name: AMY KIMBALL
Title or Position: PARTNER
Credential: PT, ATC
Phone: 319-233-6995