Provider Demographics
NPI:1104904168
Name:PHYSICAL THERAPY AND REHABILITATION SPECIALIST INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND REHABILITATION SPECIALIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-993-3517
Mailing Address - Street 1:1205 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1715
Mailing Address - Country:US
Mailing Address - Phone:515-993-3517
Mailing Address - Fax:515-993-5473
Practice Address - Street 1:1205 GREENE ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1715
Practice Address - Country:US
Practice Address - Phone:515-993-3517
Practice Address - Fax:515-993-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66504OtherBLUE CROSS
IA0665042Medicaid
IA166504Medicare ID - Type UnspecifiedMEDICARE