Provider Demographics
NPI:1902190259
Name:UNIVERSAL THERAPY GROUP LLC
Entity Type:Organization
Organization Name:UNIVERSAL THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINNAMON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VILLEBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BS, OTR/L
Authorized Official - Phone:319-750-1911
Mailing Address - Street 1:2750 MOUNT PLEASANT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2750 MOUNT PLEASANT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2136
Practice Address - Country:US
Practice Address - Phone:319-750-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-04
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty