Basic Information
| Provider Information | |||||||||
| NPI: | 1669609194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY REHAB OF IOWA, LLC | ||||||||
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| OtherOrganizationName: | COMMUNITY REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511012016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122770507 | ||||||||
| FaxNumber: | 7122770456 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511012016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122770507 | ||||||||
| FaxNumber: | 7122770456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 07/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | THEILER | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4027213908 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.