Provider Demographics
NPI:1972122463
Name:SHIELDS, KOLLEEN CASEY
Entity type:Individual
Prefix:
First Name:KOLLEEN
Middle Name:CASEY
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 PRAIRIE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-8001
Mailing Address - Country:US
Mailing Address - Phone:319-467-8220
Mailing Address - Fax:
Practice Address - Street 1:2701 PRAIRIE MEADOW DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-8001
Practice Address - Country:US
Practice Address - Phone:319-351-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist