Provider Demographics
NPI:1215181714
Name:THE PHYSICAL THERAPY CENTER OF CEDAR RAPIDS, PC
Entity Type:Organization
Organization Name:THE PHYSICAL THERAPY CENTER OF CEDAR RAPIDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DONOHOE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:319-310-2133
Mailing Address - Street 1:600 BLAIRS FERRY RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1475
Mailing Address - Country:US
Mailing Address - Phone:319-310-2133
Mailing Address - Fax:
Practice Address - Street 1:600 BLAIRS FERRY RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1475
Practice Address - Country:US
Practice Address - Phone:319-310-2133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01075261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy