# ORTHO SPINE & PAIN CLINIC LLC

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

## Provider details

- **NPI number:** 1558662395
- **Authorized official:** COLLEEN LOUW MPT (OWNER)
- **Authorized official phone:** (515) 733-2699

## Contact information

- **Practice address:** 618 BROAD ST, SUITE A, STORY CITY, IA 50248-1255
- **Practice address phone:** (208) 467-9117
- **Practice address fax:** (515) 733-2744
- **Mailing address:** 2965 E TARPON DR, SUITE 150, MERIDIAN, ID 83642-9009
- **Mailing address phone:** (515) 733-2707
- **Mailing address fax:** (515) 733-2744

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 004383 | NULL | Yes |
| 225100000X | Physical Therapist | 004383 | — | Yes |
| 2251N0400X | Neurology Physical Therapist | 004383 | IA | — |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 11/10/2010
- **Last updated:** 04/30/2013