Healthcare Provider Details

I. General information

NPI: 1235396912
Provider Name (Legal Business Name): ROCK VALLEY PHYSICAL THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 2ND ST NW
WAVERLY IA
50677-2619
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 319-352-0102
  • Fax: 319-352-0104
Mailing address:
  • Phone: 309-743-2070
  • Fax: 309-743-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RANDY E BOLDT
Title or Position: CFO
Credential: P.T.
Phone: 309-743-2070