Organization
STATERA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE LEE HUTCHISON PT (OWNER)
(563) 580-0243
Entity
Organization
Contact information
Practice address
3375 LAKE RIDGE DRIVE, DUBUQUE, IA 52003
(563) 580-0243
Mailing address
3375 LAKE RIDGE DRIVE, DUBUQUE, IA 52003
(563) 580-0243
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/24/2018
Last updated
01/24/2018
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