Provider Demographics
NPI:1982658316
Name:VAN UTRECHT, TERESA ANN (PT)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:VAN UTRECHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-9517
Mailing Address - Country:US
Mailing Address - Phone:563-381-1590
Mailing Address - Fax:
Practice Address - Street 1:2109 CEDARWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2661
Practice Address - Country:US
Practice Address - Phone:563-288-6787
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist