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General NPI Number Information
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NPI Number | 1356065031
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Entity Type | Individual
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Provider Name | ELIZABETH IMM PT
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Gender | Female
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 8525 URBANDALE AVE
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City | URBANDALE
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State | IA
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Zip | 50322-4108
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Country | US
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Telephone | 515-331-0970
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Fax |
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Provider Business Mailing Address
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Address Line | 7251 ENGLE RD STE 350
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City | MIDDLEBURG HEIGHTS
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State | OH
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Zip | 44130-3419
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 114356
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License Number State | IA
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