Provider Demographics
NPI:1780687939
Name:AGAPE THERAPY CLINIC PC
Entity Type:Organization
Organization Name:AGAPE THERAPY CLINIC PC
Other - Org Name:AGAPE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-277-3166
Mailing Address - Street 1:211 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2859
Mailing Address - Country:US
Mailing Address - Phone:319-277-3166
Mailing Address - Fax:319-266-4846
Practice Address - Street 1:211 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2859
Practice Address - Country:US
Practice Address - Phone:319-277-3166
Practice Address - Fax:319-266-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA139650800OtherU.S. DEPTARTMENT OF LABOR
IAIB3732Medicare Oscar/Certification
IA16-6538OtherMEDICARE ID/OSCAR
IA139650800OtherU.S. DEPTARTMENT OF LABOR