Taylor Ann Blickenderfer
Individual provider Active NPI Physical Therapist · Clear Lake, IA
NPI 1194515908 · NPPES record last updated May 27, 2025
Key facts
- NPI
- 1194515908
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 130234 (IA)
- Practice address
- 7 S 8TH St Ste C
Clear Lake, IA 50428-1978 - Phone
- (641) 548-8499
- NPI assigned
- May 7, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Athletico LTD
Practice addresses (Care Compare)
7 S 8TH St
Suite C Athletico Physical Therapy
Clear Lake, IA 50428-1927
Phone (641) 357-1003
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250604004227 | IA | Practitioner - Physical Therapist in Private Practice | 6406365956 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 130234 | IA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletico LTD | Physical Therapist | Current |
Accepting new patients |
| Athletico LTD | Physical Therapist | Current |
Accepting new patients |
Locations
3252 Ridge Pt
Bettendorf, IA 52722
Phone (563) 332-4995
7 S 8th St
Ste C
Clear Lake, IA 50428
Phone (641) 357-1003
2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 130234 | IA | Yes |
Addresses
Primary practice location
7 S 8TH St Ste C
Clear Lake, IA 50428-1978
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-1980
Other providers in Clear Lake, IA
- Sydney Rae Bermel
- Bieber Dental PLLC
- Elizabeth Bieber
- Matthew Bieber
- Thomas W Bieber
- Sheila Boekelman-Gelhaus
- Margaret Bowen
- John Brady
- McKenzie Brekken
- Lindsey Noelle Brickey
All providers in Clear Lake, IA · Physical Therapist in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.