Provider Demographics
NPI:1063448801
Name:PHYSICAL THERAPY SPECIALISTS PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:POSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:712-234-8760
Mailing Address - Street 1:PO BOX 1533
Mailing Address - Street 2:PHYSICAL THERAPY SPECIALISTS PC
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1533
Mailing Address - Country:US
Mailing Address - Phone:712-234-8760
Mailing Address - Fax:712-234-8765
Practice Address - Street 1:915 PIERCE ST.
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1031
Practice Address - Country:US
Practice Address - Phone:712-234-8760
Practice Address - Fax:712-234-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IA225100000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0214924Medicaid
IA214924Medicaid
IACH1150OtherRR MEDICARE
IA6347440001Medicare NSC
IACH1150OtherRR MEDICARE
IACH1150Medicare PIN