Provider Demographics
NPI:1710205943
Name:FULL CIRCLE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FULL CIRCLE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:563-608-2061
Mailing Address - Street 1:1953 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-8826
Mailing Address - Country:US
Mailing Address - Phone:563-608-2061
Mailing Address - Fax:563-927-8138
Practice Address - Street 1:1953 145TH AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-8826
Practice Address - Country:US
Practice Address - Phone:563-608-2061
Practice Address - Fax:563-927-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty