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General NPI Number Information
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NPI Number | 1790140234
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Entity Type | Organization
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Legal Business Name | SPORTSPLUS PHYSICAL THERAPY GC LLC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 606 E 1ST ST
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City | GRUNDY CENTER
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State | IA
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Zip | 50638
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Country | US
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Telephone | 319-825-6636
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Fax | 319-825-4939
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Provider Business Mailing Address
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Address Line | 606 E 1ST ST
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City | GRUNDY CENTER
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State | IA
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Zip | 50638-2046
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Country | US
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Telephone | 319-825-6636
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Fax | 319-825-4939
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Authorized Official
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Title or Position | DIRECTOR
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Name | SCOTT CARNAHAN
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Credential |
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Telephone | 319-825-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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