Provider Demographics
NPI:1023206588
Name:BIELEFELD, TRAVIS DAVID (DPT)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:DAVID
Last Name:BIELEFELD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 S SCOTT BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-2909
Mailing Address - Country:US
Mailing Address - Phone:319-354-2429
Mailing Address - Fax:
Practice Address - Street 1:4000 RIVER RIDGE DR NE STE 3
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7586
Practice Address - Country:US
Practice Address - Phone:319-200-3063
Practice Address - Fax:319-249-2399
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA166546Medicaid
IA0665463Medicaid