Basic Information
| Provider Information | |||||||||
| NPI: | 1083606024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IEDEMA | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | PT,MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6800 LAKE DR | ||||||||
| Address2: | STE 250 | ||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502662500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158759925 | ||||||||
| FaxNumber: | 5158759923 | ||||||||
| Practice Location | |||||||||
| Address1: | 5950 UNIVERSITY AVE | ||||||||
| Address2: | STE 285 | ||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502668216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158759706 | ||||||||
| FaxNumber: | 5158759707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 03591 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.