Provider Demographics
NPI:1497182653
Name:PUTNEY, EMILY ELIZABETH (ATC)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E J ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436-1664
Mailing Address - Country:US
Mailing Address - Phone:641-585-1550
Mailing Address - Fax:
Practice Address - Street 1:605 E J ST STE 200
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-1664
Practice Address - Country:US
Practice Address - Phone:641-585-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0011412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001141OtherSTATE LICSENSURE