Provider Demographics
NPI:1316583107
Name:MACH3 PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:MACH3 PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, FOUNDER, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CMPT, ATC
Authorized Official - Phone:309-264-3926
Mailing Address - Street 1:106 APPLE CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-1198
Mailing Address - Country:US
Mailing Address - Phone:309-264-3926
Mailing Address - Fax:
Practice Address - Street 1:938 EAST HILLCREST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125
Practice Address - Country:US
Practice Address - Phone:309-264-3926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy