NPIMap

Organization Active NPI

Jason J. Putz Physical Therapy P.C.

  • Physical Therapy Clinic/Center
  • Dyersville, IA
National Provider Identifier
1306033568
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
03051 Issued in IA
Legal business name
JASON J. PUTZ PHYSICAL THERAPY P.C.
Practice address
613 1/2 16TH Ave SE
Dyersville, IA 52040-2050
Phone
(563) 875-8615
Fax
(563) 875-8722
NPI assigned
Oct 1, 2007
Last updated
Oct 24, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Authorized official

Name
Jason J Putz, P.T.NPI 1114972775
Title
Director/Physical Therapist
Phone
(563) 875-8615

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 03051 IA Primary

Addresses

Primary practice location

613 1/2 16TH Ave SE
Dyersville, IA 52040-2050

Mailing address

613 1/2 16TH Ave SE
Dyersville, IA 52040-2050
Phone (563) 875-8615

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071024000183 IA Part B Supplier - Clinic/Group Practice 2769578657 Receives reassigned benefits from 18 practitioners
Practice locations: Dubuque, IA; Dyersville, IA; Manchester, IA

National Provider Directory

National Provider Directory

Locations

245 Railroad Ave
Ste F2
Dubuque, IA 52003
Phone (563) 231-9900

1129 11th St SE
Ste A
Dyersville, IA 52040
Phone (563) 875-8615

107 S 11th St
Ste 1
Manchester, IA 52057
Phone (563) 927-1499

1210 W Main St
Manchester, IA 52057
Phone (563) 927-1499

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1306033568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 1/2 16TH AVE SE",
            "city": "DYERSVILLE",
            "state": "IA",
            "postal_code": "520402050",
            "telephone_number": "563-875-8615",
            "fax_number": "563-875-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 1/2 16TH AVE SE",
            "city": "DYERSVILLE",
            "state": "IA",
            "postal_code": "520402050",
            "telephone_number": "563-875-8615",
            "fax_number": "563-875-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON J. PUTZ PHYSICAL THERAPY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "PUTZ",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "563-875-8615",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IA",
            "license": "03051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyersville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.