MEDICARE: TEAL MARIE ROUNDS PTA

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	225200000X	Physical Therapy Assistant	125304	IA

General Provider Information

NPI Number	:	1972333599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAL MARIE ROUNDS PTA

Provider Business Mailing Address
First Line	:	810 17TH ST SW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-1748
Country	:	US
Telephone Number	:	319-551-1484
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 HICKORY TRL
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-3579
Country	:	US
Telephone Number	:	515-523-4916
Fax Number	:

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

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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