Organization
PROVIDENCE THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENE R GILLUND (OFFICE MANAGER)
(563) 359-4054
Entity
Organization
Contact information
Practice address
21037 HOLDEN DRIVE, DAVENPORT, IA 52804
(563) 359-4054
(563) 359-4084
Mailing address
21037 HOLDEN DRIVE, DAVENPORT, IA 52804
(563) 359-4054
(563) 359-4084
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0474460
—
IA
Enumeration date
12/11/2006
Last updated
08/22/2020
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