Provider Demographics
NPI:1477077030
Name:VANLEEUWEN, MARIJKE (DPT)
Entity Type:Individual
Prefix:
First Name:MARIJKE
Middle Name:
Last Name:VANLEEUWEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2807
Mailing Address - Country:US
Mailing Address - Phone:610-876-6180
Mailing Address - Fax:
Practice Address - Street 1:3605 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2807
Practice Address - Country:US
Practice Address - Phone:610-876-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6203929225100000X
COPTL.0015052225100000X
PAPT025137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist