Provider Demographics
NPI:1922016856
Name:LANAGHAN, MICHAEL RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:LANAGHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:1705 SOUTH 1ST AVE
Practice Address - Street 2:SUITE C
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6037
Practice Address - Country:US
Practice Address - Phone:319-337-8818
Practice Address - Fax:319-337-8308
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0278952Medicaid
31275OtherWELLMARK
I7893Medicare ID - Type Unspecified