Provider Demographics
NPI:1578975140
Name:STRAWHACKER, KRISTEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:STRAWHACKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:STRAWHACKER BONZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:815 OFFICE PARK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2502
Mailing Address - Country:US
Mailing Address - Phone:515-346-8636
Mailing Address - Fax:866-346-8292
Practice Address - Street 1:815 OFFICE PARK RD STE 3
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2502
Practice Address - Country:US
Practice Address - Phone:515-346-8636
Practice Address - Fax:866-346-8292
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB3481012Medicare PIN
IAI19172074Medicare PIN
IAIB3481Medicare PIN
IAI19172Medicare PIN