Provider Demographics
NPI:1578683033
Name:FLORES, EMMANUEL JR. DY-LIACCO (PT)
Entity Type:Individual
Prefix:
First Name:EMMANUEL JR.
Middle Name:DY-LIACCO
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 12TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2527
Mailing Address - Country:US
Mailing Address - Phone:515-576-6524
Mailing Address - Fax:515-955-2463
Practice Address - Street 1:2700 1ST AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4306
Practice Address - Country:US
Practice Address - Phone:515-955-6922
Practice Address - Fax:515-955-2463
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist