Provider Demographics
NPI:1770571218
Name:VOYLES, JOHN TIMOTHY (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TIMOTHY
Last Name:VOYLES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTH EAST IOWA PHYSICAL THERAPY
Mailing Address - Street 2:115 S WASHINGTON ST
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2531
Mailing Address - Country:US
Mailing Address - Phone:641-682-8171
Mailing Address - Fax:641-682-9054
Practice Address - Street 1:SOUTH EAST IOWA PHYSICAL THERAPY
Practice Address - Street 2:115 S WASHINGTON ST
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2531
Practice Address - Country:US
Practice Address - Phone:641-682-8171
Practice Address - Fax:641-682-9054
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33884OtherBCBS INDIVIDUAL NUMBER
IA6-6534OtherBCBS GROUP PROVIDER #
IA0665349Medicaid
IA16-6534Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER