Basic Information
| Provider Information | |||||||||
| NPI: | 1578078812 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCK VALLEY THERAPY SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 43RD AVE STE 100 | ||||||||
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| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612658401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097432070 | ||||||||
| FaxNumber: | 3097432073 | ||||||||
| Practice Location | |||||||||
| Address1: | 2109 CEDARWOOD DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MUSCATINE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527612670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632630557 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2017 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| NPIDeactivationDate: | 03/01/2018 | ||||||||
| NPIReactivationDate: | 08/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | BOLDT | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3097432070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.