# IMPACT PHYSICAL THERAPY AND WELLNESS LLC

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

## Provider details

- **NPI number:** 1487151775
- **Authorized official:** DR. KEITH ALAN ROED PT, DPT, CMPT (PHYSICAL THERAPIST/OWNER)
- **Authorized official phone:** (712) 560-0460

## Contact information

- **Practice address:** 4295 SERGEANT RD, SIOUX CITY, IA 51106
- **Practice address phone:** (515) 664-2149
- **Mailing address:** 4295 SERGEANT RD, SIOUX CITY, IA 51106-4625
- **Mailing address phone:** (712) 560-0460
- **Mailing address fax:** (712) 560-0460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 004816 | IA | Yes |

## Other

- **Enumeration date:** 04/12/2018
- **Last updated:** 06/21/2018