Healthcare Provider Details

I. General information

NPI: 1710923891
Provider Name (Legal Business Name): ADRIAAN LOUW PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 BROAD ST SUITE A
STORY CITY IA
50248-1255
US

IV. Provider business mailing address

618 BROAD ST SUITE A
STORY CITY IA
50248-1255
US

V. Phone/Fax

Practice location:
  • Phone: 515-733-2707
  • Fax: 515-733-2744
Mailing address:
  • Phone: 515-733-2707
  • Fax: 515-733-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-02778
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03403
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: