Bryan Boardsen, MOT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

002042 Issued in IA

Practice address

815 W Tower Park Dr
Waterloo, IA 50701-9026

Phone

(319) 233-6995

Fax

(319) 233-7083

NPI assigned

Sep 23, 2008

Last updated

Apr 11, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rock Valley Physical Therapy Center

  • Physical Therapist
  • Moline, IL
  • NPI 1245373166

  Occupational Therapist

  NPD (past)

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334102400000",
    "number": "1700036043",
    "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": "815 W TOWER PARK DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507019026",
            "telephone_number": "319-233-6995",
            "fax_number": "319-233-7083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOARDSEN",
        "first_name": "BRYAN",
        "credential": "MOT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-23",
        "last_updated": "2012-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056-008438",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IA",
            "license": "002042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA PT LICENSE NUMBER",
            "identifier": "002042",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Ann Bloom, ARNP, FNP-C
• Michael J Blough, DC
• Rachel Sue Blough
• Wayde Russell Blumhardt, CRNA
• Kathryn Marie Boaldin, DPT
• Ann Marie Bock, MSN,ARNP, FNP-C
• Zubair Hassan Bodla, M.D.
• Steven D Boeke, O.D.
• Vinko M Bogdanic, M.D.
• Kayln Marie Boge-Kleiss, ARNP

• Occupational Therapist in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Occupational Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; 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.