Provider Demographics
NPI:1023546728
Name:ALT, THERESA MARIE (PT, DPT, GCS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:ALT
Suffix:
Gender:F
Credentials:PT, DPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1308
Mailing Address - Country:US
Mailing Address - Phone:319-447-1132
Mailing Address - Fax:
Practice Address - Street 1:1140 ELIM DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-5817
Practice Address - Country:US
Practice Address - Phone:319-377-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA030322251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics