Provider Demographics
NPI:1538171368
Name:VANHOORNBEEK, WILLIAM JANSEN (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JANSEN
Last Name:VANHOORNBEEK
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 1:1028 W BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1809
Mailing Address - Country:US
Mailing Address - Phone:417-777-2888
Mailing Address - Fax:417-777-4597
Practice Address - Street 1:1028 W BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1809
Practice Address - Country:US
Practice Address - Phone:417-777-2888
Practice Address - Fax:417-777-4597
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487223604Medicaid
MO487223604Medicaid