# GREAT LAKES PHYSICAL THERAPY, PC

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

## Provider details

- **NPI number:** 1255646709
- **Authorized official:** DAVID JON HALLAND PT (PHYSICAL THERAPIST)
- **Authorized official phone:** (712) 320-2722

## Contact information

- **Practice address:** 3301 BERGQUIST AVE, SPIRIT LAKE, IA 51360-7268
- **Practice address phone:** (712) 336-2722
- **Mailing address:** 3301 BERGQUIST AVEUE, SPIRIT LAKE, IA 51360-7268

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 00807 | IA | — |
| 261QP2000X | Physical Therapy Clinic/Center | 00868 | IA | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | 01261 | IA | — |
| 261QP2000X | Physical Therapy Clinic/Center | 01929 | IA | — |
| 261QP2000X | Physical Therapy Clinic/Center | 03253 | IA | — |
| 261QR0400X | Rehabilitation Clinic/Center | 01681 | IA | — |
| 261QR0401X | Comprehensive Outpatient Rehabilitation Facility (CORF) | 055168 | IA | — |

## Other

- **Enumeration date:** 08/09/2010
- **Last updated:** 08/09/2010