Provider Demographics
NPI:1497811624
Name:VAN HUNNIK, OLAV J (RPT)
Entity Type:Individual
Prefix:
First Name:OLAV
Middle Name:J
Last Name:VAN HUNNIK
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2003
Mailing Address - Country:US
Mailing Address - Phone:727-742-2003
Mailing Address - Fax:
Practice Address - Street 1:499 ALT KEENE RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1652
Practice Address - Country:US
Practice Address - Phone:727-586-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist