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General NPI Number Information
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NPI Number | 1538021811
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Entity Type | Organization
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Legal Business Name | DES MOINES SPORTS INSTITUTE
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 250 DELAWARE ST STE 120
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City | NORWALK
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State | IA
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Zip | 50211-8916
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Country | US
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Telephone | 641-417-9910
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Fax |
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Provider Business Mailing Address
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Address Line | 5120 HARDING ST
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City | PROLE
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State | IA
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Zip | 50229-9182
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Country | US
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Telephone | 641-417-9910
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ANDREW BRODERICK
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Credential | DPT
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Telephone | 641-417-9910
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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 |
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License Number State |
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