Provider Demographics
NPI:1366492050
Name:VANHOOK, STEPHEN ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:VANHOOK
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 1:2002 JOHNSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3640
Mailing Address - Country:US
Mailing Address - Phone:337-824-4547
Mailing Address - Fax:337-824-4548
Practice Address - Street 1:2002 JOHNSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3640
Practice Address - Country:US
Practice Address - Phone:337-824-4547
Practice Address - Fax:337-824-4548
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X975CB91Medicare PIN