Kristie L Boll, DPT
Individual provider Active NPI Physical Therapist · Prophetstown, IL
NPI 1861663023 · NPPES record last updated Apr 11, 2012
Key facts
- NPI
- 1861663023
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070-016288 (IL)
- Practice address
- 321 Washington St
Prophetstown, IL 61277-1105 - Phone
- (815) 537-8899
- Fax
- (815) 537-8802
- NPI assigned
- Mar 17, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rock Valley Physical Therapy Center
Practice addresses (Care Compare)
4451 E 53Rd St
Suite 200
Davenport, IA 52807-3142
Phone (563) 362-0016
850 43Rd Ave
Moline, IL 61265-8401
Phone (309) 743-0900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080509000295 | IL | Practitioner - Physical Therapist in Private Practice | 6800975244 | Reassigns benefits to 1 organization |
| I20160414000333 | IA | Practitioner - Physical Therapist in Private Practice | 6800975244 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004225 | IA | MD | Physical Therapist |
| 070-016288 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rock Valley Physical Therapy Center | Physical Therapist | Current |
Accepting new patients |
| Rock Valley Physical Therapy Center | Physical Therapist | Current |
Accepting new patients |
Locations
1705 N Ankeny Blvd
Ste A
Ankeny, IA 50023
Phone (515) 446-0733
1427 S Washington Blvd
Camanche, IA 52730
Phone (563) 259-4440
2635 Lincoln Way
Ste C
Clinton, IA 52732
Phone (563) 243-8321
1905 Ingersoll Ave
Ste 104
Des Moines, IA 50309
Phone (515) 369-2306
3414 Northport Dr
Ste 2
Muscatine, IA 52761
Phone (563) 263-2639
419 W Bridge Rd
Ste A
Polk City, IA 50226
Phone (515) 984-6377
5700 University Ave
Ste 222
West Des Moines, IA 50266
Phone (309) 743-2070
850 43rd Ave
Ste 200
Moline, IL 61265
Phone (309) 743-0300
850 43rd Ave
Ste 100
Moline, IL 61265
Phone (309) 743-2070
850 43rd Ave
Ste 300
Moline, IL 61265
Phone (309) 743-0300
9901 N Knoxville Ave
Ste D
Peoria, IL 61615
Phone (309) 243-1989
321 Washington St
Prophetstown, IL 61277
Phone (815) 537-8899
9317A Il Route 84
Savanna, IL 61074
Phone (815) 273-2628
1013 N Cummings Ln
Washington, IL 61571
Phone (309) 444-1030
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-016288 | IL | Yes |
| Physical Therapist | 225100000X | 004225 | IA |
Addresses
Primary practice location
321 Washington St
Prophetstown, IL 61277-1105
Mailing address
850 43Rd Ave Ste 100
Moline, IL 61265-8401
Phone (309) 743-2070
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070-016288 | Other | IL | ILLINOIS PT LICENSE NO |
Other names
- Kristie L Gravel
Other providers in Prophetstown, IL
- Aaron Thomas Wachtel, DDS
- Allure of Prophetstown, LLC
- James S Bleecker
- Sherwood Donald Bryan
- Kristine Byer
- Amy Caldwell
- Kelly Jo Carter
- Timothy S Chamberlain
All providers in Prophetstown, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.