Provider Demographics
NPI:1801179288
Name:VAN VLIET, BRYAN N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:N
Last Name:VAN VLIET
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 COLORADO AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2706
Mailing Address - Country:US
Mailing Address - Phone:209-216-3360
Mailing Address - Fax:209-216-3365
Practice Address - Street 1:1801 COLORADO AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2706
Practice Address - Country:US
Practice Address - Phone:209-216-3360
Practice Address - Fax:209-216-3365
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist