Provider Demographics
NPI:1902863475
Name:VANHOUTEN, KRISTOPHER MARC (DPT)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:MARC
Last Name:VANHOUTEN
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 1:1515 LINDEN ST.
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3020
Mailing Address - Country:US
Mailing Address - Phone:515-288-0569
Mailing Address - Fax:515-288-0347
Practice Address - Street 1:1515 LINDEN ST.
Practice Address - Street 2:FLOOR 1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3020
Practice Address - Country:US
Practice Address - Phone:515-288-0569
Practice Address - Fax:515-288-0347
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1033289749Medicaid
IA1033289749Medicare Oscar/Certification
IA1285772970Medicare NSC