Provider Demographics
NPI:1225461072
Name:VAN DUSEN, DOUGLAS (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:VAN DUSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 GRAY AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-671-8378
Mailing Address - Fax:530-660-8451
Practice Address - Street 1:851 GRAY AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3652
Practice Address - Country:US
Practice Address - Phone:530-632-1707
Practice Address - Fax:530-751-9035
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT249942251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports