Provider Demographics
NPI:1457982373
Name:KLOPFENSTEIN, VINCE ANDREW (ATC)
Entity Type:Individual
Prefix:
First Name:VINCE
Middle Name:ANDREW
Last Name:KLOPFENSTEIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 PRAIRIE HILL DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9018
Mailing Address - Country:US
Mailing Address - Phone:319-750-1591
Mailing Address - Fax:
Practice Address - Street 1:2410 PRAIRIE HILL DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-9018
Practice Address - Country:US
Practice Address - Phone:319-750-1591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer