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Organization
EASTERN IOWA THERAPEUTICS P.C.
Active
Organization
EASTERN IOWA THERAPEUTICS P.C.
Active
Other names
Athletico Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JUANA GRANADOS (CREDENTIALING MANAGER)
(630) 575-1980
Entity
Organization
Contact information
Practice address
155 CEDAR RIVER PARKWAY, SUITE 101, WAVERLY, IA 50677
(319) 483-0002
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 590-4029
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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