Provider Demographics
NPI:1053657007
Name:TEEL-MULKA, RENE R (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:R
Last Name:TEEL-MULKA
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:413 S MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:BLUE GRASS
Practice Address - State:IA
Practice Address - Zip Code:52726-9127
Practice Address - Country:US
Practice Address - Phone:563-381-8793
Practice Address - Fax:563-381-9912
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist