Provider Demographics
NPI:1043633860
Name:VAN VALKENBURGH, COY (MS, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:COY
Middle Name:
Last Name:VAN VALKENBURGH
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-6778
Mailing Address - Country:US
Mailing Address - Phone:936-615-4829
Mailing Address - Fax:
Practice Address - Street 1:1024 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-6778
Practice Address - Country:US
Practice Address - Phone:936-615-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT36192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer