Provider Demographics
NPI:1700986304
Name:TOTAL REHAB-ORTHOPEDIC AND SPORTS SPECIALIST, P.C.
Entity Type:Organization
Organization Name:TOTAL REHAB-ORTHOPEDIC AND SPORTS SPECIALIST, P.C.
Other - Org Name:TOTAL REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:641-236-4506
Mailing Address - Street 1:234 WEST ST S
Mailing Address - Street 2:SOUTHVIEW PLAZA SUITE #4
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-8160
Mailing Address - Country:US
Mailing Address - Phone:641-236-4506
Mailing Address - Fax:641-236-4316
Practice Address - Street 1:234 WEST ST S
Practice Address - Street 2:SOUTHVIEW PLAZA SUITE #4
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-8160
Practice Address - Country:US
Practice Address - Phone:641-236-4506
Practice Address - Fax:641-236-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3382225100000X
IA04029225100000X
IA004152225100000X
IA1432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0461624Medicaid
IA71749OtherBCBS AMY BAKER
IA38554OtherBLUE CROSS BLUE SHIELD PR
IADD6529OtherRAILROAD MEDICARE-GROUP #
IA06735OtherBCBS LINDA DAVIS
IAI14912Medicare PIN
IA38554OtherBLUE CROSS BLUE SHIELD PR
IA06735OtherBCBS LINDA DAVIS
IAI14912 001Medicare PIN