Individual
CARRIE MARIE VANQUATHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PT
Contact information
Practice address
5406 MERLE HAY RD, JOHNSTON, IA 50131-1209
(515) 727-8750
(515) 727-8757
Mailing address
4105 80TH ST, URBANDALE, IA 50322-2419
(515) 727-2348
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02595
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42911
WELLMARK BCBS
IA
Enumeration date
05/01/2007
Last updated
07/08/2007
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