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General NPI Number Information
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NPI Number | 1306033568
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Entity Type | Organization
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Legal Business Name | JASON J. PUTZ PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 613 1/2 16TH AVE SE
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City | DYERSVILLE
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State | IA
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Zip | 52040-2050
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Country | US
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Telephone | 563-875-8615
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Fax | 563-875-8722
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Provider Business Mailing Address
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Address Line | 613 1/2 16TH AVE SE
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City | DYERSVILLE
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State | IA
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Zip | 52040-2050
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Country | US
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Telephone | 563-875-8615
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Fax | 563-875-8722
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Authorized Official
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Title or Position | DIRECTOR/PHYSICAL THERAPIST
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Name | JASON J PUTZ
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Credential | P.T.
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Telephone | 563-875-8615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 03051
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License Number State | IA
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