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General NPI Number Information
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NPI Number | 1629963772
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Entity Type | Individual
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Provider Name | JONATHAN P ITA DPT
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Gender | Male
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 100 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1032
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Country | US
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Telephone | 319-353-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 1044 NEWTON RD APT 4
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City | IOWA CITY
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State | IA
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Zip | 52246-2258
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Country | US
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Telephone | 319-201-8308
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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 | 132812
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License Number State | IA
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