Basic Information
Provider Information
NPI: 1861682890
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIRKEY
FirstName: DAVID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 205 W WACKER DR
Address2: SUITE 1020
City: CHICAGO
State: IL
PostalCode: 606061216
CountryCode: US
TelephoneNumber: 3126400329
FaxNumber: 3124233234
Practice Location
Address1: 452 & 454 SE UNIVERSITY
Address2:  
City: WAUKEE
State: IA
PostalCode: 502638121
CountryCode: US
TelephoneNumber: 5159870465
FaxNumber: 5159870929
Other Information
ProviderEnumerationDate: 07/26/2007
LastUpdateDate: 09/11/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X004077IAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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