Provider Demographics
NPI:1205848488
Name:LOUW, COLLEEN F (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:F
Last Name:LOUW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N ANKENY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1750
Mailing Address - Country:US
Mailing Address - Phone:515-965-5311
Mailing Address - Fax:515-965-5301
Practice Address - Street 1:618 BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1255
Practice Address - Country:US
Practice Address - Phone:515-965-5311
Practice Address - Fax:515-965-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108636225100000X
IA4383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36699014OtherBCBS PROVIDER #
IAI19172Medicare PIN
IAI19172030Medicare PIN