Provider Demographics
NPI:1225308745
Name:VAN VELZEN, REGINALD (PT)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:VAN VELZEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 MERRITT ST. WEST
Mailing Address - Street 2:
Mailing Address - City:WELLAND
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L3C 4T9
Mailing Address - Country:CA
Mailing Address - Phone:905-641-7675
Mailing Address - Fax:
Practice Address - Street 1:5217 82ND ST UNIT 104
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2800
Practice Address - Country:US
Practice Address - Phone:806-687-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1214108225100000X
AZ9648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist