Basic Information
| Provider Information | |||||||||
| NPI: | 1083668768 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONE TO ONE PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 GRAND AVE | ||||||||
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| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503125305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152373974 | ||||||||
| FaxNumber: | 5158832692 | ||||||||
| Practice Location | |||||||||
| Address1: | 758 216TH DR | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502127520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152754003 | ||||||||
| FaxNumber: | 5152754122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 03/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | SHANTEL | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 5152754003 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S.P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | DD0340 | 01 | IA | RAILROAD MEDICARE | OTHER | 0453407 | 05 | IA | MEDICAID |