Provider Demographics
NPI:1912975087
Name:UHRLAUB, MICHAEL BRIAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:UHRLAUB
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE EDMUNDSON PLACE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4619
Mailing Address - Country:US
Mailing Address - Phone:712-323-5333
Mailing Address - Fax:712-323-3252
Practice Address - Street 1:ONE EDMUNDSON PLACE
Practice Address - Street 2:SUITE 500
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4619
Practice Address - Country:US
Practice Address - Phone:712-323-5333
Practice Address - Fax:712-323-3252
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16828Medicare ID - Type Unspecified
Q61584Medicare UPIN
IAI16913Medicare ID - Type Unspecified