Provider Demographics
NPI:1790911626
Name:EASTERN IOWA PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:EASTERN IOWA PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESSNER
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:563-732-4317
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778-0688
Mailing Address - Country:US
Mailing Address - Phone:563-732-4317
Mailing Address - Fax:
Practice Address - Street 1:413 S MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:BLUE GRASS
Practice Address - State:IA
Practice Address - Zip Code:52726-9127
Practice Address - Country:US
Practice Address - Phone:563-381-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16660100Medicare Oscar/Certification