Provider Demographics
NPI:1174875199
Name:TOTAL REHAB-ORTHOPEDIC & SPORTS SPECIALISTS, P.C.
Entity type:Organization
Organization Name:TOTAL REHAB-ORTHOPEDIC & SPORTS SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:641-236-4506
Mailing Address - Street 1:234 WEST ST S
Mailing Address - Street 2:SOUTHVIEW PLAZA SUITE #4
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-8160
Mailing Address - Country:US
Mailing Address - Phone:641-236-4506
Mailing Address - Fax:641-236-4316
Practice Address - Street 1:509 COURT STREET
Practice Address - Street 2:FRONT OFFICE
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361-9999
Practice Address - Country:US
Practice Address - Phone:641-236-4506
Practice Address - Fax:641-236-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0461624Medicaid