Provider Demographics
NPI:1710317706
Name:DAM, MARIEKE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:MARIEKE
Middle Name:
Last Name:DAM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 DOCTOR AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4820
Mailing Address - Country:US
Mailing Address - Phone:772-538-5337
Mailing Address - Fax:
Practice Address - Street 1:1155 35TH LN
Practice Address - Street 2:100
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6521
Practice Address - Country:US
Practice Address - Phone:772-569-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist