Provider Demographics
NPI:1790700433
Name:VAN DER LINDE, RALPH VICTOR (PT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:VICTOR
Last Name:VAN DER LINDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 KIMBERLY BLVD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2855
Mailing Address - Country:US
Mailing Address - Phone:561-482-6900
Mailing Address - Fax:561-482-6023
Practice Address - Street 1:9070 KIMBERLY BLVD
Practice Address - Street 2:SUITE 24
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2855
Practice Address - Country:US
Practice Address - Phone:561-482-6900
Practice Address - Fax:561-482-6023
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-3558497OtherTAX ID
FL20-3558497OtherTAX ID