Provider Demographics
NPI:1528160249
Name:VAN GORP, BARBARA J (MPT, DPT, CSCS)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:VAN GORP
Suffix:
Gender:F
Credentials:MPT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE EDMUNDSON PLACE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503
Mailing Address - Country:US
Mailing Address - Phone:712-388-0150
Mailing Address - Fax:712-323-3252
Practice Address - Street 1:ONE EDMUNDSON PLACE
Practice Address - Street 2:SUITE 500
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503
Practice Address - Country:US
Practice Address - Phone:712-323-5333
Practice Address - Fax:712-323-3252
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03941225100000X
WI9662024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist