Provider Demographics
NPI:1639427669
Name:VERSTRAETE, JEANNIE MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:MARIE
Last Name:VERSTRAETE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29970 260TH ST
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:IA
Mailing Address - Zip Code:52248-8632
Mailing Address - Country:US
Mailing Address - Phone:309-236-5538
Mailing Address - Fax:
Practice Address - Street 1:29970 260TH ST
Practice Address - Street 2:
Practice Address - City:KEOTA
Practice Address - State:IA
Practice Address - Zip Code:52248-8632
Practice Address - Country:US
Practice Address - Phone:309-236-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004920225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant