Individual provider Active NPI

Rene R Teel-Mulka, P.T., D.P.T., O.C.S.

  • Physical Therapist
  • Blue Grass, IA
National Provider Identifier
1053657007
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
004878 Issued in IA
Practice address
413 S Mississippi St
Blue Grass, IA 52726-9127
Phone
(563) 381-8793
Fax
(563) 381-9912
NPI assigned
Dec 19, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 004878 IA Primary

Addresses

Primary practice location

413 S Mississippi St
Blue Grass, IA 52726-9127

Mailing address

850 43Rd Ave Ste 100
Moline, IL 61265-8401
Phone (309) 743-2070

Other practice location 1

8056 127th Street
Blue Grass, IA 52726
Phone (563) 340-6934

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150416002256 IA Practitioner - Physical Therapist in Private Practice 4587982871 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1700 N Division St
Suite 200
Davenport, IA 52804-3535
Phone (563) 324-2263

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004878IAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Jan 1, 2018 Accepting new patients
Rock Valley Physical Therapy Center Physical Therapist CurrentSince Jan 1, 2018 Accepting new patients

Locations

1700 N Division St
Ste 200
Davenport, IA 52804
Phone (563) 324-2263

2109 Cedarwood Dr
Ste 100
Muscatine, IA 52761
Phone (563) 288-6787

400 Ovesen Dr
Wilton, IA 52778
Phone (563) 732-2121

850 43rd Ave
Ste 100
Moline, IL 61265
Phone (309) 743-2070

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1053657007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 43RD AVE STE 100",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658401",
            "telephone_number": "309-743-2070",
            "fax_number": "309-743-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 S MISSISSIPPI ST",
            "city": "BLUE GRASS",
            "state": "IA",
            "postal_code": "527269127",
            "telephone_number": "563-381-8793",
            "fax_number": "563-381-9912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8056 127th Street",
            "address_purpose": "LOCATION",
            "city": "Blue Grass",
            "state": "IA",
            "postal_code": "52726",
            "country_code": "US",
            "telephone_number": "563-340-6934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEEL-MULKA",
        "first_name": "RENE",
        "middle_name": "R",
        "credential": "P.T., D.P.T., O.C.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-19",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "004878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Grass, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.