Basic Information
| Provider Information | |||||||||
| NPI: | 1174708689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STRIDES THERAPY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2397 OLD HIGHWAY 92 | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502568534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416211122 | ||||||||
| FaxNumber: | 6416211177 | ||||||||
| Practice Location | |||||||||
| Address1: | 604 LIBERTY ST | ||||||||
| Address2: | STE 229 | ||||||||
| City: | PELLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502191775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417808041 | ||||||||
| FaxNumber: | 6416211177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 10/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | DECIOUS | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6417808041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 02356 | IA | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 01692 | IA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.