Provider Demographics
NPI:1316369770
Name:COMMUNITY REHAB OF IOWA LLC
Entity Type:Organization
Organization Name:COMMUNITY REHAB OF IOWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-614-7775
Mailing Address - Street 1:2410 E 7TH ST
Mailing Address - Street 2:#100
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1961
Mailing Address - Country:US
Mailing Address - Phone:712-243-2267
Mailing Address - Fax:712-243-2671
Practice Address - Street 1:2410 E 7TH ST
Practice Address - Street 2:#100
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1961
Practice Address - Country:US
Practice Address - Phone:712-243-2267
Practice Address - Fax:712-243-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-19
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADN7419OtherRR MEDICARE
IAPENDINGOtherIOWA MEDICAID
IADN7419OtherRR MEDICARE