Provider Demographics
NPI:1710923891
Name:LOUW, ADRIAAN (PT)
Entity Type:Individual
Prefix:
First Name:ADRIAAN
Middle Name:
Last Name:LOUW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 BROAD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-1255
Mailing Address - Country:US
Mailing Address - Phone:515-733-2707
Mailing Address - Fax:515-733-2744
Practice Address - Street 1:618 BROAD ST
Practice Address - Street 2:SUITE A
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1255
Practice Address - Country:US
Practice Address - Phone:515-733-2707
Practice Address - Fax:515-733-2744
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02778225100000X
IA03403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172Medicare PIN
IAI19172026Medicare PIN