NPIMap

Organization Active NPI

Clinton Physical Therapy Services

Doing business as Plaza Physical Therapy

  • Durable Medical Equipment & Medical Supplies
  • Davenport, IA
National Provider Identifier
1265612238
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
CLINTON PHYSICAL THERAPY SERVICES
Doing business as
Plaza Physical Therapy
Practice address
3385 Dexter CT
Davenport, IA 52807-3471
Phone
(563) 344-6645
Fax
(563) 441-7796
NPI assigned
Nov 7, 2007
Last updated
Jun 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Authorized official

Name
Gary D Vande Kamp, P.T.
Title
President
Phone
(563) 357-0305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

3385 Dexter CT
Davenport, IA 52807-3471

Mailing address

3385 Dexter CT
Davenport, IA 52807-3471
Phone (563) 344-6645

Other identifiers 1

IdentifierTypeStateIssuer
0111013OtherIAMEDICAID DME

Other names 1

  • Plaza Physical Therapy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clinton Physical Therapy Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1265612238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3385 DEXTER CT",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073471",
            "telephone_number": "563-344-6645",
            "fax_number": "563-441-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3385 DEXTER CT",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073471",
            "telephone_number": "563-344-6645",
            "fax_number": "563-441-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON PHYSICAL THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "VANDE KAMP",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "563-357-0305",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "0111013",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plaza Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.