Individual
GERALD BOUSLOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
604 LOCUST ST, SUITE 210, DES MOINES, IA 50309-3705
(515) 282-7019
(515) 282-7213
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 282-7219
(515) 282-7213
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02853
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0475145
—
IA
Enumeration date
08/16/2006
Last updated
04/14/2009
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