Provider Demographics
NPI:1528224664
Name:PHYSICAL MEDICINE & REHABILITATION ASSOCIATES OF NORTHEAST IOWA, INC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE & REHABILITATION ASSOCIATES OF NORTHEAST IOWA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:FREDERIK
Authorized Official - Last Name:MANSHASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-234-0109
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-0238
Mailing Address - Country:US
Mailing Address - Phone:319-234-0109
Mailing Address - Fax:319-234-5774
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5036
Practice Address - Country:US
Practice Address - Phone:319-369-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27493208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1110OtherMEDICARE GROUP IB1110