Provider Demographics
NPI:1609291038
Name:PROFESSIONAL PHYSICAL THERAPY SEVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL PHYSICAL THERAPY SEVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:641-342-5340
Mailing Address - Street 1:15500 555TH ST
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:IA
Mailing Address - Zip Code:50151-8473
Mailing Address - Country:US
Mailing Address - Phone:641-342-5340
Mailing Address - Fax:641-342-5372
Practice Address - Street 1:800 S FILLMORE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1619
Practice Address - Country:US
Practice Address - Phone:641-342-5340
Practice Address - Fax:641-342-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03896261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy