NPIMap

Organization Active NPI

Rock Valley Physical Therapy Center

  • Physical Therapist
  • Clinton, IA
National Provider Identifier
1366724874
Registry record updated Sep 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ROCK VALLEY PHYSICAL THERAPY CENTER
Practice address
931 13TH Ave N
Clinton, IA 52732-5072
Phone
(563) 243-7814
Fax
(563) 243-2441
NPI assigned
Sep 12, 2011
Last updated
Sep 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2011

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

Authorized official

Name
Randy E Boldt, PT
Title
Cfo
Phone
(309) 743-2070

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

931 13TH Ave N
Clinton, IA 52732-5072

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0565937MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111111000589 IA DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 9638087877 Practice locations: Clinton, IA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1366724874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 43RD AVE",
            "address_2": "SUITE 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": "931 13TH AVE N",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527325072",
            "telephone_number": "563-243-7814",
            "fax_number": "563-243-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCK VALLEY PHYSICAL THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "BOLDT",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "309-743-2070",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0565937",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.