Provider Demographics
NPI:1629321476
Name:VAN BATUM, BERNARD AUGUST (PT)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:AUGUST
Last Name:VAN BATUM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 N ACADEMY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3687
Mailing Address - Country:US
Mailing Address - Phone:719-532-1100
Mailing Address - Fax:719-532-1109
Practice Address - Street 1:5426 N ACADEMY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3687
Practice Address - Country:US
Practice Address - Phone:719-532-1100
Practice Address - Fax:719-532-1109
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist