Jessica Sage Boldenow
Individual provider Active NPI Physical Therapist · Council Bluffs, IA
NPI 1558287656 · NPPES record last updated Jun 26, 2026
Key facts
- NPI
- 1558287656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- CP059115T (IA)
- Practice address
- 3134 Manawa Centre Dr
Council Bluffs, IA 51501-7690 - Phone
- (712) 308-8038
- Fax
- (712) 524-1055
- NPI assigned
- Jun 24, 2026
- Sex
- Female
- Sole proprietor
- No
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2026
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Athletico LTD
Practice addresses (Care Compare)
3134 Manawa Centre Dr
Council Bluffs, IA 51501-7690
Phone (712) 308-8038
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | CP059115T | IA | Yes |
Addresses
Primary practice location
3134 Manawa Centre Dr
Council Bluffs, IA 51501-7690
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Other providers in Council Bluffs, IA
- Karen M Bober
- Blake Michael Bodendorfer
- Karly Boehm
- Clifford Kent Boese
- Bogaard and Associates, LLC
- Scott B Bomgaars
- Richard Boothby Jr.
- Jessica Bortolotti Burke
- Jason Alan Bouska
- Keely Nicole Bouska
All providers in Council Bluffs, 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 Jun 26, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- 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.