MEDICARE: TIME OF YOUR LIFE THERAPY

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	261QP2000X	Physical Therapy Clinic/Center	02217	IA

General Provider Information

NPI Number	:	1669600029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIME OF YOUR LIFE THERAPY

Provider Business Mailing 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	:	319-354-3826

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	:	319-354-3826

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KRISTINE MARIE MACE
Credential	:	PT
Telephone Number	:	319-354-3824

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	02/10/2015

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Directions to “TIME OF YOUR LIFE THERAPY ” Practice Location

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