Provider Demographics
NPI:1184992414
Name:AT HOME THERAPY PC
Entity type:Organization
Organization Name:AT HOME THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STECKLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:563-542-6631
Mailing Address - Street 1:16778 CORDILLERA DR
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-7016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:563-557-7007
Practice Address - Street 1:16778 CORDILLERA DR
Practice Address - Street 2:
Practice Address - City:PEOSTA
Practice Address - State:IA
Practice Address - Zip Code:52068-7016
Practice Address - Country:US
Practice Address - Phone:563-542-6631
Practice Address - Fax:563-557-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1487921946OtherNPI ISSUED FOR ME AS AN INDIVIDUAL PRACTITIONER ABLE TO PROVIDE PT SERVICES