Provider Demographics
NPI:1316561897
Name:VANHOUTEN, JACOB RICHARD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:RICHARD
Last Name:VANHOUTEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BROOKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-2426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1187 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:VA
Practice Address - Zip Code:23950-1768
Practice Address - Country:US
Practice Address - Phone:434-447-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic