# INTEGRATED PHYSICAL THERAPY AND SPORTS MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083963037
- **Authorized official:** TATE C VAN HOUTEN DPT (OWNER/PHYSICAL THERAPIST)
- **Authorized official phone:** (515) 288-0569

## Contact information

- **Practice address:** 1515 LINDEN ST, SUITE 100, DES MOINES, IA 50309-3120
- **Practice address phone:** (515) 288-0569
- **Practice address fax:** (515) 288-0347
- **Mailing address:** 2213 GRAND AVE, DES MOINES, IA 50312-5305
- **Mailing address phone:** (515) 237-3974
- **Mailing address fax:** (515) 883-2692

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2012
- **Last updated:** 11/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | IN PROCESS | — | IA |