Provider Demographics
NPI:1669600029
Name:TIME OF YOUR LIFE THERAPY
Entity type:Organization
Organization Name:TIME OF YOUR LIFE THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:319-354-3824
Mailing Address - Street 1:434 HIGHWAY 1 W
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4204
Mailing Address - Country:US
Mailing Address - Phone:319-354-3824
Mailing Address - Fax:319-354-3826
Practice Address - Street 1:434 HIGHWAY 1 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4204
Practice Address - Country:US
Practice Address - Phone:319-354-3824
Practice Address - Fax:319-354-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02217261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy