Provider Demographics
NPI:1861523326
Name:DUBUQUE PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:DUBUQUE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:563-588-3891
Mailing Address - Street 1:4005 WESTMARK DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2271
Mailing Address - Country:US
Mailing Address - Phone:563-588-3891
Mailing Address - Fax:563-588-3893
Practice Address - Street 1:4005 WESTMARK DR
Practice Address - Street 2:SUITE 320
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2271
Practice Address - Country:US
Practice Address - Phone:563-588-3891
Practice Address - Fax:563-588-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAU3051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA25550OtherGROUP BCBS NUMBER
IA1174699128OtherNPI WILLIAM O'DELL
IA0129189Medicaid
IA1114972775OtherNPI JASON PUTZ
IA1669411922OtherNPI MEL HARVEY
IA1750320016OtherNPI JASON MEYER
IA0129189Medicaid