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NPI Code Detail

MEDICARE: ROCK VALLEY PHYSICAL THERAPY CENTER

MEDICARE: ROCK VALLEY PHYSICAL THERAPY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist
2225100000XPhysical Therapist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1555640OTHERILMEDICARE
2555650OTHERILMEDICARE

General Provider Information

NPI Number : 1336421841
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCK VALLEY PHYSICAL THERAPY CENTER
Provider Business Mailing Address
First Line : 850 43RD AVE
Second Line : SUITE 100
City : MOLINE
State : IL
Zip : 61265-8401
Country : US
Telephone Number : 309-743-2070
Fax Number : 309-743-2073
Provider Business Practice Location Address
First Line : 635 E LINCOLNWAY
Second Line :
City : MORRISON
State : IL
Zip : 61270-2963
Country : US
Telephone Number : 815-772-7277
Fax Number : 815-772-4590
Authorized Official
Title or Position : CFO
Name : RANDY E BOLDT
Credential : PT
Telephone Number : 309-743-2070
Provider Enumeration Date : 09/12/2011
Last Update Date : 09/12/2011

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Directions to “ROCK VALLEY PHYSICAL THERAPY CENTER ” Practice Location

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