Provider Demographics
NPI:1629579131
Name:PHYSIOCARE CORPORATE SOLUTIONS
Entity Type:Organization
Organization Name:PHYSIOCARE CORPORATE SOLUTIONS
Other - Org Name:PHYSIOCARE WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLENCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:605-670-2532
Mailing Address - Street 1:1403 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-3745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1809
Practice Address - Country:US
Practice Address - Phone:605-670-2532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare