Provider Demographics
NPI:1760540926
Name:MATCH PLAY TENNIS CENTERS, INC.
Entity Type:Organization
Organization Name:MATCH PLAY TENNIS CENTERS, INC.
Other - Org Name:REC CENTER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-295-8899
Mailing Address - Street 1:400 COLLINS RD NE
Mailing Address - Street 2:BLDG 154-100
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52498-0001
Mailing Address - Country:US
Mailing Address - Phone:319-295-8899
Mailing Address - Fax:319-295-8833
Practice Address - Street 1:400 COLLINS RD NE
Practice Address - Street 2:BLDG 154-100
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52498-0001
Practice Address - Country:US
Practice Address - Phone:319-295-8899
Practice Address - Fax:319-295-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1066154OtherUSAMCO GROUP NUMBER
IA37850OtherWELLMARK GROUP NUMBER
IAF245873OtherMIDLANDS CHOICE ID NUMBER
IA5747352OtherFIRST HEALTH GROUP NUMBER
IAF245873OtherMIDLANDS CHOICE ID NUMBER