Provider Demographics
NPI:1316215205
Name:ROCKWELL, DUSTIN M (PTA)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:M
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 N ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-1837
Mailing Address - Country:US
Mailing Address - Phone:970-497-0251
Mailing Address - Fax:
Practice Address - Street 1:314 S ELM AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:IA
Practice Address - Zip Code:51546-1442
Practice Address - Country:US
Practice Address - Phone:712-644-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004852314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility