Basic Information
| Provider Information | |||||||||
| NPI: | 1053755835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASSER SCOTT | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502668203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152412200 | ||||||||
| FaxNumber: | 5152412201 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502668203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152412200 | ||||||||
| FaxNumber: | 5152412201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 01953 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 226300000X | 01953 | IA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Kinesiotherapist |
ID Information
| ID | Type | State | Issuer | Description | 1053755835 | 05 | IA | MEDICAID |