Provider Demographics
NPI:1023206588
Name:BIELEFELD, TRAVIS DAVID (DPT)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:DAVID
Last Name:BIELEFELD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 TOWNCREST DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6631
Mailing Address - Country:US
Mailing Address - Phone:319-354-2429
Mailing Address - Fax:
Practice Address - Street 1:585 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9797
Practice Address - Country:US
Practice Address - Phone:319-665-2665
Practice Address - Fax:319-665-2677
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665463Medicaid
IA166546Medicaid