Provider Demographics
NPI:1124394085
Name:UNIVERSAL THERAPY GROUP
Entity Type:Organization
Organization Name:UNIVERSAL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CINNAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-752-7899
Mailing Address - Street 1:411 W AGENCY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1704
Mailing Address - Country:US
Mailing Address - Phone:319-752-7899
Mailing Address - Fax:
Practice Address - Street 1:411 W AGENCY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1704
Practice Address - Country:US
Practice Address - Phone:319-752-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty