Provider Demographics
NPI:1225239858
Name:HENTZEN, ROB F (PT, MBA)
Entity Type:Individual
Prefix:MR
First Name:ROB
Middle Name:F
Last Name:HENTZEN
Suffix:
Gender:M
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1065 BROWNS WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-8360
Mailing Address - Country:US
Mailing Address - Phone:515-331-3190
Mailing Address - Fax:515-331-3191
Practice Address - Street 1:4725 MERLE HAY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-331-3190
Practice Address - Fax:515-331-3191
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA131372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist