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General NPI Number Information
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NPI Number | 1902596562
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Entity Type | Organization
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Legal Business Name | PROVEN PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 601 SNYDER RD
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City | WOODBINE
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State | IA
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Zip | 51579-1123
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Country | US
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Telephone | 712-318-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 2417 EASTON TRL
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City | PISGAH
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State | IA
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Zip | 51564-4029
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Country | US
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Telephone | 712-318-1919
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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 | DR. MARISSA KAY KNOTT
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Credential | DPT
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Telephone | 712-318-1919
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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 |
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