Basic Information
| Provider Information | |||||||||
| NPI: | 1194020487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUEY | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 222 | ||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502668224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152211621 | ||||||||
| FaxNumber: | 5152211626 | ||||||||
| Practice Location | |||||||||
| Address1: | 5700 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 222 | ||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502668224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152211621 | ||||||||
| FaxNumber: | 5152211626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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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 | 004668 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0565937 | 05 | IA | MEDICAID |