Provider Demographics
NPI:1558868117
Name:VAN NIEKERK, ELZA (PT)
Entity Type:Individual
Prefix:
First Name:ELZA
Middle Name:
Last Name:VAN NIEKERK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8680 BAYMEADOWS RD E APT 1235
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3997
Mailing Address - Country:US
Mailing Address - Phone:904-504-3226
Mailing Address - Fax:
Practice Address - Street 1:869 STOCKTON ST STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3588
Practice Address - Country:US
Practice Address - Phone:904-504-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33366208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation