Organization
CLINTON PHYSICAL THERAPY SERVICES
Active
Other names
Plaza Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
GARY D VANDE KAMP P.T. (PRESIDENT)
(563) 357-0305
Entity
Organization
Contact information
Practice address
3385 DEXTER CT, DAVENPORT, IA 52807-3471
(563) 344-6645
(563) 441-7796
Mailing address
3385 DEXTER CT, DAVENPORT, IA 52807-3471
(563) 344-6645
(563) 441-7796
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0111013
MEDICAID DME
IA
Enumeration date
11/07/2007
Last updated
06/27/2008
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