Provider Demographics
NPI:1275509341
Name:DE VLEESCHAUWER, PETER (RP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:DE VLEESCHAUWER
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 LINTON BLVD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-865-2800
Mailing Address - Fax:561-865-0037
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE E-2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-865-2800
Practice Address - Fax:561-865-0037
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0011417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY069MOtherBLUE CROSS BLUE SHIELD
FLP00259560OtherRAILROAD MEDICARE
FLU2103BMedicare ID - Type Unspecified