Basic Information
| Provider Information | |||||||||
| NPI: | 1245706902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOESTER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 OAKMONT LN STE 600C | ||||||||
| Address2: | |||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305904029 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2707 STANGE RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500103965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156634824 | ||||||||
| FaxNumber: | 5156634860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2018 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004032 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.