Provider Demographics
NPI:1750766952
Name:EASTERN IOWA THERAPEUTICS PC
Entity type:Organization
Organization Name:EASTERN IOWA THERAPEUTICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-575-1980
Mailing Address - Street 1:5300 FOUNTAINS DR NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-6607
Mailing Address - Country:US
Mailing Address - Phone:319-378-6958
Mailing Address - Fax:319-378-6938
Practice Address - Street 1:5300 FOUNTAINS DR NE
Practice Address - Street 2:SUITE 106
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52411-6607
Practice Address - Country:US
Practice Address - Phone:319-378-6958
Practice Address - Fax:319-378-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty