Provider Demographics
NPI:1912146259
Name:DUSDIEKER, ALYSON CAROL (LPT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:CAROL
Last Name:DUSDIEKER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9509
Mailing Address - Country:US
Mailing Address - Phone:319-354-5114
Mailing Address - Fax:319-354-0804
Practice Address - Street 1:2751 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9509
Practice Address - Country:US
Practice Address - Phone:319-354-5114
Practice Address - Fax:319-354-0804
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI75560030OtherMEDICARE PTAN
IA0665463Medicaid