NPIMap

Organization Active NPI

Sports Rehab and Professional Therapy Associates Inc

Doing business as Sports Rehab & Professional Therapy

  • Rehabilitation Clinic/Center
  • Storm Lake, IA
National Provider Identifier
1033289749
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
SPORTS REHAB AND PROFESSIONAL THERAPY ASSOCIATES INC
Doing business as
Sports Rehab & Professional Therapy
Practice address
315 W 5TH St
Storm Lake, IA 50588-1743
Phone
(712) 732-7724
Fax
(712) 560-9253
NPI assigned
Nov 9, 2006
Last updated
Apr 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Theresa Lynn Godfrey
Title
Clinic Admin Director
Phone
(402) 334-6025

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary
Occupational Therapy Assistant 224Z00000X
Physical Therapist 225100000X
Physical Therapy Assistant 225200000X
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

315 W 5TH St
Storm Lake, IA 50588-1743

Mailing address

315 W 5TH St
Storm Lake, IA 50588-1743
Phone (712) 732-7724

Other practice location 1

1101 N 2nd St
Cherokee, IA 51012-1199
Phone (712) 225-3344

Other practice location 2

521 Highway 39 Unit 4
Denison, IA 51442-2726
Phone (712) 393-7724

Other identifiers 1

IdentifierTypeStateIssuer
0665141MedicaidIA

Other names 1

  • Sports Rehab & Professional Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030102000021 IA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 1658289608 Practice locations: Cherokee, IA; Storm Lake, IA; Denison, IA
O20260603000833 IA Part B Supplier - Clinic/Group Practice 1658289608 Receives reassigned benefits from 1 practitioner
Practice locations: Storm Lake, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033289749. Details of each certification follow.

  • CCN 166514 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 166514

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SPORTS REHAB AND PROFESSIONAL THERAPY ASSOC INC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jan 6, 1983
Last certification
Mar 1, 2023
Ownership / control type
Proprietary
Facility address
315 West Fifth Street
Storm Lake, IA 50588

National Provider Directory

National Provider Directory

Locations

1101 N 2nd St
Cherokee, IA 51012
Phone (712) 225-3344

521 Highway 39
Denison, IA 51442
Phone (712) 393-7724

521 Highway 39
Ste 4
Denison, IA 51442

521 Highway 39
Unit 4
Denison, IA 51442
Phone (712) 393-7724

Practitioners & affiliated clinicians

Practitioners 169

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 169

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1033289749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W 5TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505881743",
            "telephone_number": "712-732-7724",
            "fax_number": "712-732-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W 5TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505881743",
            "telephone_number": "712-732-7724",
            "fax_number": "712-560-9253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 N 2nd St",
            "address_purpose": "LOCATION",
            "city": "Cherokee",
            "state": "IA",
            "postal_code": "510121199",
            "country_code": "US",
            "telephone_number": "712-225-3344",
            "fax_number": "712-560-9257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "521 Highway 39 Unit 4",
            "address_purpose": "LOCATION",
            "city": "Denison",
            "state": "IA",
            "postal_code": "514422726",
            "country_code": "US",
            "telephone_number": "712-393-7724",
            "fax_number": "712-560-9259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPORTS REHAB AND PROFESSIONAL THERAPY ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CLINIC ADMIN DIRECTOR",
        "authorized_official_telephone_number": "402-334-6025"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0665141",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Rehab & Professional Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Storm Lake, IA

Sources for this page

Verify at the official NPI Registry.