Provider Demographics
NPI:1619018504
Name:VAN PELT & ASSOCIATES PHYSICAL THERAPY SERVICES PA
Entity Type:Organization
Organization Name:VAN PELT & ASSOCIATES PHYSICAL THERAPY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN PELT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-395-2920
Mailing Address - Street 1:3848 FAU BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-395-2920
Mailing Address - Fax:561-395-2960
Practice Address - Street 1:3848 FAU BLVD
Practice Address - Street 2:STE 105
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-395-2920
Practice Address - Fax:561-997-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY915VOtherBCBS OF FL
FL6565890001Medicare NSC
FLK1312Medicare PIN