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General NPI Number Information
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NPI Number | 1669877056
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Entity Type | Organization
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Legal Business Name | BLUEPRINT PEDIATRIC THERAPY, PLC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 2387 MEHAFFEY BRIDGE RD NE
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-9348
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Country | US
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Telephone | 319-333-4490
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Fax |
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Provider Business Mailing Address
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Address Line | 2387 MEHAFFEY BRIDGE RD NE
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-9348
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Country | US
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Telephone | 319-333-4490
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. RACHEL LYNN KONGSHAUG
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Credential | PT, MPT, PCS
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Telephone | 319-333-4490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3530
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License Number State | IA
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