Provider Demographics
NPI:1689822488
Name:THE PHYSICAL THERAPY CENTER, PC
Entity Type:Organization
Organization Name:THE PHYSICAL THERAPY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:563-355-3867
Mailing Address - Street 1:1747 E. 54TH ST.
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2769
Mailing Address - Country:US
Mailing Address - Phone:563-355-3867
Mailing Address - Fax:563-355-0806
Practice Address - Street 1:1747 E. 54TH ST.
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2769
Practice Address - Country:US
Practice Address - Phone:563-355-3867
Practice Address - Fax:563-355-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0239624Medicaid
IA23962Medicare UPIN