Organization
GREAT LAKES PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID JON HALLAND PT (PHYSICAL THERAPIST)
(712) 320-2722
Entity
Organization
Contact information
Practice address
3301 BERGQUIST AVE, SPIRIT LAKE, IA 51360-7268
(712) 336-2722
Mailing address
3301 BERGQUIST AVEUE, SPIRIT LAKE, IA 51360-7268
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
00807
IA
261QP2000X
Physical Therapy Clinic/Center
Primary
00868
IA
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
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