Provider Demographics
NPI:1710088794
Name:VAN ZANT, DAVID DEAN (PT DPT DCS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DEAN
Last Name:VAN ZANT
Suffix:
Gender:M
Credentials:PT DPT DCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:APPLEGATE
Mailing Address - State:CA
Mailing Address - Zip Code:95703
Mailing Address - Country:US
Mailing Address - Phone:530-878-2741
Mailing Address - Fax:
Practice Address - Street 1:375 BRUNSWICK RD SUITE 102
Practice Address - Street 2:900 WHISPERING PINES LANE
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-272-4284
Practice Address - Fax:530-272-2990
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist