Individual
STACI LILIEDAHL-MATIYOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
201 W BROADWAY, COUNCIL BLUFFS, IA 51503-9004
(712) 329-9419
(712) 329-0329
Mailing address
201 W BROADWAY, COUNCIL BLUFFS, IA 51503-9004
(712) 329-9419
(712) 329-0329
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03634
IA
225100000X
Physical Therapist
2218
NE
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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