=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417654716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIANA CULLINAN DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2023
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1504 S STORY ST STE 6
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50036-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-236-9014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 461
-----------------------------------------------------
City | NEVADA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50201-0461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-382-3366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 118169
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------