Provider Demographics
NPI:1790770436
Name:VAN CAMP, GREGORY JAMES (DPT, AT, C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAMES
Last Name:VAN CAMP
Suffix:
Gender:M
Credentials:DPT, AT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4741
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-4741
Mailing Address - Country:US
Mailing Address - Phone:714-904-6436
Mailing Address - Fax:
Practice Address - Street 1:1800 E LAMBERT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4370
Practice Address - Country:US
Practice Address - Phone:714-256-5074
Practice Address - Fax:714-256-0770
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26560Medicare ID - Type UnspecifiedMEDICARE NUMBER