Provider Demographics
NPI:1790344844
Name:VAN NUTT, GARRETT CHARLES (DPT)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:CHARLES
Last Name:VAN NUTT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 VINYARD RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-3632
Mailing Address - Country:US
Mailing Address - Phone:540-343-0466
Mailing Address - Fax:540-345-2261
Practice Address - Street 1:1110 VINYARD RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3632
Practice Address - Country:US
Practice Address - Phone:540-343-0466
Practice Address - Fax:540-345-2261
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist