Organization
ROCK VALLEY PHYSICAL THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY E BOLDT P.T. (CFO)
(309) 743-2070
Entity
Organization
Contact information
Practice address
112 2ND ST NW, WAVERLY, IA 50677-2619
(319) 352-0102
(319) 352-0104
Mailing address
850 43RD AVE, SUITE 100, MOLINE, IL 61265-8401
(309) 743-2070
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IA
225X00000X
Occupational Therapist
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565937
GROUP BILLING # FOR MEDICAID
IA
01
—
I18344
GROUP BILLING # FOR MEDICARE
IA
Enumeration date
05/20/2008
Last updated
03/30/2009
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