Provider Demographics
NPI:1619392461
Name:DANA VAN PELT INC
Entity Type:Organization
Organization Name:DANA VAN PELT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN PELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-395-2920
Mailing Address - Street 1:3848 FAU BLVD
Mailing Address - Street 2:SUITE 105
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:
Practice Address - Street 1:3848 FAU BLVD
Practice Address - Street 2:SUITE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy