Provider Demographics
NPI:1417235243
Name:HOOGEVEEN, ANDREW JAY (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAY
Last Name:HOOGEVEEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4330
Mailing Address - Country:US
Mailing Address - Phone:712-264-6198
Mailing Address - Fax:712-264-6312
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4330
Practice Address - Country:US
Practice Address - Phone:712-264-6198
Practice Address - Fax:712-264-6312
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist