Provider Demographics
NPI:1699068841
Name:PROACTIVE PHYSICAL THERAPY AND SPORTS REHAB
Entity type:Organization
Organization Name:PROACTIVE PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:712-722-1902
Mailing Address - Street 1:301 10TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1529
Mailing Address - Country:US
Mailing Address - Phone:712-324-0110
Mailing Address - Fax:712-324-0031
Practice Address - Street 1:301 10TH ST
Practice Address - Street 2:STE C
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1529
Practice Address - Country:US
Practice Address - Phone:712-324-0110
Practice Address - Fax:712-324-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty