Provider Demographics
NPI:1679056998
Name:VANPELT, PHILLIP (DPT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:VANPELT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:PHILLIP
Other - Middle Name:S
Other - Last Name:VAN PELT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 419666
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9666
Mailing Address - Country:US
Mailing Address - Phone:410-970-8190
Mailing Address - Fax:
Practice Address - Street 1:3742 10TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1820
Practice Address - Country:US
Practice Address - Phone:202-269-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist