Jaclyn Marie Bormann, LPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4058 Issued in IA

Practice address

111 Highway 150 N
West Union, IA 52175-1050

Phone

(563) 334-3400

NPI assigned

Oct 15, 2009

Last updated

Jun 1, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Marie Oldham Former name

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rock Valley Physical Therapy CenterGroup PAC ID 9638087877, 232 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

  IA

  Medicare reassignment Care Compare group NPD
• Rock Valley Physical Therapy Center

  • Occupational Therapist
  • Eldridge, IA
  • NPI 1881540490

  Physical Therapist

  NPD

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

{
    "created_epoch": "1255564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1720313273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 43RD AVE STE 100",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658401",
            "telephone_number": "309-743-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HIGHWAY 150 N",
            "city": "WEST UNION",
            "state": "IA",
            "postal_code": "521751050",
            "telephone_number": "563-334-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORMANN",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "credential": "LPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-15",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "4058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "OLDHAM",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Bruce C Baker, PA
• Kenneth Bryan Beach, CRNA
• Bigler Chiropractic Clinic
• Lew D. Bishop, AUD
• Kyle Brandt
• Melinda Sue Brokaw, CNP ARNP
• Patricia Carey, DPT
• Cedar Valley Medical Specialists PC (West Union Dialysis Center)
• Alyssa Cobie-Nuss, TLMHC

• Physical Therapist in West Union, IA
• Providers in West Union, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.