Basic Information
Provider Information | |||||||||
NPI: | 1508079849 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | POPPE | ||||||||
FirstName: | DEBRA | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | P.T. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RIDENOUR | ||||||||
OtherFirstName: | DEBRA | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1200 PLEASANT ST | ||||||||
Address2: | SOUTH 2 ROOM 236 | ||||||||
City: | DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 503091406 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152416228 | ||||||||
FaxNumber: | 5152418685 | ||||||||
Practice Location | |||||||||
Address1: | 2006 S ANKENY BLVD | ||||||||
Address2: | BUILDING 5 | ||||||||
City: | ANKENY | ||||||||
State: | IA | ||||||||
PostalCode: | 500238995 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152899541 | ||||||||
FaxNumber: | 5154463642 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/07/2007 | ||||||||
LastUpdateDate: | 05/04/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 01224 | IA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.