Provider Demographics
NPI:1548341308
Name:VAN HOUTEN, TATE CURTIS (DPT)
Entity type:Individual
Prefix:DR
First Name:TATE
Middle Name:CURTIS
Last Name:VAN HOUTEN
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:FL 1
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3120
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1515 LINDEN ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3120
Practice Address - Country:US
Practice Address - Phone:515-288-0569
Practice Address - Fax:515-288-0347
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1548341308Medicaid
IAIB2611001Medicare PIN