Provider Demographics
NPI:1114020740
Name:VAN VLYMEN, RACHEL ELIZABETH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:VAN VLYMEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 DEANNA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2402
Mailing Address - Country:US
Mailing Address - Phone:219-696-0988
Mailing Address - Fax:219-696-0989
Practice Address - Street 1:181 DEANNA DR
Practice Address - Street 2:SUITE C
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2402
Practice Address - Country:US
Practice Address - Phone:219-696-0988
Practice Address - Fax:219-696-0989
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007497A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000213361OtherBCBS OF IN
IL90000585OtherBCBS OF IL
INP00149506OtherMEDICARE RR
IN200916840Medicaid
IN000000213361OtherBCBS OF IN