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General NPI Number Information
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NPI Number | 1790911626
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Entity Type | Organization
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Legal Business Name | EASTERN IOWA PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 413 S MISSISSIPPI ST
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City | BLUE GRASS
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State | IA
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Zip | 52726-9127
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Country | US
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Telephone | 563-381-8793
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 688
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City | WILTON
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State | IA
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Zip | 52778-0688
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Country | US
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Telephone | 563-732-4317
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BETH DESSNER
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Credential | P. T.
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Telephone | 563-732-4317
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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 |
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License Number State | IA
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