Provider Demographics
NPI:1861836454
Name:HOMETOWN PHYSICAL THERAPY HOLDING COMPANY LLC
Entity Type:Organization
Organization Name:HOMETOWN PHYSICAL THERAPY HOLDING COMPANY LLC
Other - Org Name:OKOBOJIPHYSICALTHERAPY,SPENCERPHYSICALTHERAPY,EASTVILLAGEPHYSICALTHERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-301-6262
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-0211
Mailing Address - Country:US
Mailing Address - Phone:712-336-8404
Mailing Address - Fax:712-250-2415
Practice Address - Street 1:1004 21ST ST UNIT 3
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-7421
Practice Address - Country:US
Practice Address - Phone:712-336-8404
Practice Address - Fax:712-250-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1861836454OtherNPI