=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962574640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IOWA PHYSICAL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 1ST ST SE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52314-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-895-4085
-----------------------------------------------------
Fax | 319-895-8013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 1ST ST SE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52314-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-895-4085
-----------------------------------------------------
Fax | 319-895-8013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW JOHN MARGHEIM
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 319-895-4085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------