Individual
SAMUEL NISSLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
241 SE DESTINATION DR STE 200, GRIMES, IA 50111-1249
(515) 986-5190
Mailing address
PO BOX 321, DALLAS CENTER, IA 50063-0321
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
126470
IA
Other
Enumeration date
06/21/2024
Last updated
06/21/2024
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