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General NPI Number Information
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NPI Number | 1073875779
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Entity Type | Organization
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Legal Business Name | WEST DES MOINES PHYSICAL THERAPY AND SPORTS REHABILITATION, PLLC
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Dates
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Enumeration Date | 06/09/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 3701 EP TRUE PKWY SUITE 300
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City | WEST DES MOINES
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State | IA
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Zip | 50265-7696
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Country | US
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Telephone | 515-480-8038
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Fax |
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Provider Business Mailing Address
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Address Line | 517 COLONIAL CIR
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City | WEST DES MOINES
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State | IA
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Zip | 50265-3733
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Country | US
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Telephone | 515-771-8779
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN SHELLENBERGER
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Credential | D.P.T.
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Telephone | 515-771-8779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4589
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4657
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License Number State | IA
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