| Vitality Physical Medicine Pllc | |
|
5335 Eastern Ave Ste C Davenport IA 52807-2788 | |
| (563) 424-6400 | |
| Not Available |
| Full Name | Vitality Physical Medicine Pllc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 5335 Eastern Ave Ste C, Davenport, Iowa |
| Authorized Official Name and Position | Joseph Earl Brooks (OWNER) |
| Authorized Official Contact | 5634246400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Physical Medicine Pllc 5335 Eastern Ave Ste C Davenport IA 52807-2788 Ph: () - | Vitality Physical Medicine Pllc 5335 Eastern Ave Ste C Davenport IA 52807-2788 Ph: (563) 424-6400 |
| NPI Number | 1780376129 |
|---|---|
| Provider Enumeration Date | 05/24/2023 |
| Last Update Date | 08/22/2023 |
| Medicare PECOS PAC ID | 8921467564 |
|---|---|
| Medicare Enrollment ID | O20230629003347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780376129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Joseph E Brooks |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1396904462 PECOS PAC ID: 9638232317 Enrollment ID: I20110720000563 |
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