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General NPI Number Information
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NPI Number | 1447355177
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CONSULTANTS, LC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 802 BLUFF LN
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City | LECLAIRE
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State | IA
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Zip | 52753-9396
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Country | US
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Telephone | 563-343-3908
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Fax |
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Provider Business Mailing Address
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Address Line | 802 BLUFF LN
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City | LECLAIRE
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State | IA
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Zip | 52753-9396
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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 | OWNER/DIRECTOR
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Name | MS. BETTINA J HERMISTON
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Credential | MPT, CFMT
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Telephone | 563-343-3908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 03384
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License Number State | IA
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