Provider Demographics
NPI:1740479732
Name:ERIK VAN DIJK
Entity type:Organization
Organization Name:ERIK VAN DIJK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DIJK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-264-5559
Mailing Address - Street 1:1007 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1153
Mailing Address - Country:US
Mailing Address - Phone:740-537-2000
Mailing Address - Fax:740-537-9440
Practice Address - Street 1:1007 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1153
Practice Address - Country:US
Practice Address - Phone:740-537-2000
Practice Address - Fax:740-537-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0848113Medicaid
OH0848113Medicaid
OH0701136Medicare UPIN