Active NPI
Douglas Siemen, PTA
- Physical Therapy Assistant
- West Liberty, IA
National Provider Identifier
1871968024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5076
- Practice address
- 2170 Delta Ave
West Liberty, IA 52776-9012 - Phone
- (563) 212-5593
- NPI assigned
- Dec 14, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5076 | IA | Primary |
Addresses
Primary practice location
2170 Delta Ave
West Liberty, IA 52776-9012
Mailing address
2170 Delta Ave
West Liberty, IA 52776-9012
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5076 | Other | IA | IOWA THERAPY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5076 | IA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450051200000",
"number": "1871968024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2170 DELTA AVE",
"city": "WEST LIBERTY",
"state": "IA",
"postal_code": "527769012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2170 DELTA AVE",
"city": "WEST LIBERTY",
"state": "IA",
"postal_code": "527769012",
"telephone_number": "563-212-5593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEMEN",
"first_name": "DOUGLAS",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-12-14",
"last_updated": "2015-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IA",
"license": "5076",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA THERAPY LICENSE",
"identifier": "5076",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Liberty, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.