Healthcare Provider Details

I. General information

NPI: 1083234660
Provider Name (Legal Business Name): MICHELLE LYNN MCDOWELL DPT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W AGENCY RD
WEST BURLINGTON IA
52655-1659
US

IV. Provider business mailing address

1401 W AGENCY RD
WEST BURLINGTON IA
52655-1659
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-4100
  • Fax: 319-768-4160
Mailing address:
  • Phone: 319-768-4100
  • Fax: 319-768-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03001
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: