| NPI | 1962453274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD THOMAS CARLSON CEO, Stadia Sports Medicine 515-221-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: IA 36501) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2017-08-16 |