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NPI Code Detail

MEDICARE: MARC LEE VANDERVELDEN DPT CSCS

MEDICARE: MARC LEE VANDERVELDEN DPT CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist03548IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
137197OTHERIAIND
237198OTHERIABCBS GR & MADRID
339199OTHERIABCBS AH

General Provider Information

NPI Number : 1972561637
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC LEE VANDERVELDEN DPT CSCS
Provider Business Mailing Address
First Line : 3200 WESTOWN PKWY
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-1110
Country : US
Telephone Number : 515-276-1212
Fax Number : 515-276-3194
Provider Business Practice Location Address
First Line : 3200 WESTOWN PKWY
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-1110
Country : US
Telephone Number : 515-276-1212
Fax Number : 515-276-3194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 08/07/2012

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