Provider Demographics
NPI:1447241914
Name:VAN DYKE, ARLYN R (PT)
Entity Type:Individual
Prefix:MR
First Name:ARLYN
Middle Name:R
Last Name:VAN DYKE
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 1:530 LA GONDA WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1727
Mailing Address - Country:US
Mailing Address - Phone:925-820-0518
Mailing Address - Fax:925-820-7247
Practice Address - Street 1:530 LA GONDA WAY
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1727
Practice Address - Country:US
Practice Address - Phone:925-820-0518
Practice Address - Fax:925-820-7247
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT53672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ17832ZMedicare ID - Type Unspecified