Provider Demographics
NPI:1609971225
Name:DOSTAL, AMBER LYNN (PT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:DOSTAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 TAMA ST SE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4556
Mailing Address - Country:US
Mailing Address - Phone:319-447-0700
Mailing Address - Fax:319-447-0808
Practice Address - Street 1:4700 TAMA ST SE
Practice Address - Street 2:SUITE 700
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4556
Practice Address - Country:US
Practice Address - Phone:319-447-0700
Practice Address - Fax:319-447-0808
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA030542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IAI19172Medicare PIN
IAIB1212Medicare PIN
IA0665430Medicaid
IAIB1213015Medicare PIN
IAIB1212022Medicare PIN
IAI19172049Medicare PIN