Provider Demographics
NPI:1780215723
Name:VAN HOFF, LYDIA ELLEN (DPT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ELLEN
Last Name:VAN HOFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ELLEN
Other - Last Name:RUSK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3418 LOMA VISTA RD STE A
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3015
Mailing Address - Country:US
Mailing Address - Phone:805-765-4773
Mailing Address - Fax:805-392-9975
Practice Address - Street 1:4960 VERDUGO WAY
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8632
Practice Address - Country:US
Practice Address - Phone:805-765-4773
Practice Address - Fax:805-392-9975
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist