MEDICARE: MS. KRISTINE MARIE MACE P.T.

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
1	225100000X	Physical Therapist	070014508	IL
2	225100000X	Physical Therapist	02217	IA

General Provider Information

NPI Number	:	1508838194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINE MARIE MACE P.T.

Provider Business Mailing Address
First Line	:	1240 COPPER MOUNTAIN DR
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-8827
Country	:	US
Telephone Number	:	319-631-9855
Fax Number	:

Provider Business Practice Location Address
First Line	:	434 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4204
Country	:	US
Telephone Number	:	319-354-3824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	03/01/2013

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