Healthcare Provider Details

I. General information

NPI: 1003289372
Provider Name (Legal Business Name): ORTHOPAEDIC AND NEUROLOGICAL REHABILITATION,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2015
Last Update Date: 11/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 SAINT FRANCIS DR
WATERLOO IA
50702-5442
US

IV. Provider business mailing address

2651 SAINT FRANCIS DR
WATERLOO IA
50702-5442
US

V. Phone/Fax

Practice location:
  • Phone: 319-232-6808
  • Fax:
Mailing address:
  • Phone: 319-232-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number077050
License Number StateIA

VIII. Authorized Official

Name: MR. RYAN DODD
Title or Position: REGIONAL DIRECTOR OF REHABILIATION
Credential: DPT
Phone: 641-990-3956