Provider Demographics
NPI:1437173341
Name:CARDAMON, KATHRYN (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CARDAMON
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 1:3200 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4104
Mailing Address - Country:US
Mailing Address - Phone:515-271-1717
Mailing Address - Fax:515-271-7185
Practice Address - Street 1:3200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4104
Practice Address - Country:US
Practice Address - Phone:515-271-1717
Practice Address - Fax:515-271-7185
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43-1994748OtherJOHN DEERE
IA0426072Medicaid
IA431994748OtherUNITED HEALTH CARE NUMBER
IAF241498OtherMIDLANDS CHOICE NUMBER
IA34894OtherWELLMARK BC/BS
IA0424457Medicaid
IA431994748OtherTAX ID NUMBER
IAF241498OtherMIDLANDS CHOICE NUMBER
IA431994748OtherTAX ID NUMBER