Provider Demographics
NPI:1861627408
Name:POWERS, KATHLEEN ELIZABETH (DPT, PCS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:POWERS
Suffix:
Gender:F
Credentials:DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MAPLECREST RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7709
Mailing Address - Country:US
Mailing Address - Phone:563-421-3497
Mailing Address - Fax:563-421-3699
Practice Address - Street 1:2535 MAPLECREST RD
Practice Address - Street 2:SUITE 23
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7709
Practice Address - Country:US
Practice Address - Phone:563-421-3497
Practice Address - Fax:563-421-3699
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004340Medicaid