# NEUROREACH PT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053224105
- **Authorized official:** JEFFERY WAGENAAR PT, DPT (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (712) 461-0135

## Contact information

- **Practice address:** 1142 MARY LN, NORTH LIBERTY, IA 52317-8710
- **Practice address phone:** (712) 461-0135
- **Mailing address:** 1142 MARY LN, NORTH LIBERTY, IA 52317-8710
- **Mailing address phone:** (712) 461-0135

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |

## Other

- **Enumeration date:** 09/28/2026
- **Last updated:** 09/28/2026