Jeannine Marie Knickerbocker, DPT
Individual provider Active NPI Physical Therapist · Waterloo, IA
NPI 1962561969 · NPPES record last updated Dec 7, 2007
Key facts
- NPI
- 1962561969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 03966 (IA)
- Practice address
- 1731 W Ridgeway Ave
Waterloo, IA 50701-4594 - Phone
- (319) 833-5900
- Fax
- (319) 833-5901
- NPI assigned
- Dec 6, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 03966 | IA | Yes |
Addresses
Primary practice location
1731 W Ridgeway Ave
Waterloo, IA 50701-4594
Mailing address
PO Box 2758
Waterloo, IA 50704-2758
Phone (319) 235-5390
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0744060 | Medicaid | IA | |
| 29208 | Other | WELLMARK |
Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.