Provider Demographics
NPI:1194020487
Name:HUEY, SAMUEL I (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:I
Last Name:HUEY
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 1:5700 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8224
Mailing Address - Country:US
Mailing Address - Phone:515-221-1621
Mailing Address - Fax:515-221-1626
Practice Address - Street 1:5700 UNIVERSITY AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8224
Practice Address - Country:US
Practice Address - Phone:515-221-1621
Practice Address - Fax:515-221-1626
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0565937Medicaid
IA0565937Medicaid
IAI19172Medicare PIN
IAI18344Medicare PIN