Provider Demographics
NPI:1578448882
Name:PURSELL, MCCOLM THAI DIEN (ATC)
Entity type:Individual
Prefix:
First Name:MCCOLM
Middle Name:THAI DIEN
Last Name:PURSELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 UNIVERSITY AVE APT 321
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-4517
Mailing Address - Country:US
Mailing Address - Phone:913-201-1807
Mailing Address - Fax:
Practice Address - Street 1:4600 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-2254
Practice Address - Country:US
Practice Address - Phone:913-201-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer