Provider Demographics
NPI:1194139741
Name:VICKERS, EMILY (PT, DPT, PCS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:VICKERS
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PCS
Mailing Address - Street 1:583 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3620
Mailing Address - Country:US
Mailing Address - Phone:615-308-5193
Mailing Address - Fax:
Practice Address - Street 1:1377 11TH ST NW
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5068
Practice Address - Country:US
Practice Address - Phone:563-241-4230
Practice Address - Fax:563-519-4235
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0048412251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics