Provider Demographics
NPI:1922564558
Name:VAN RIJ, STEPHEN M
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:VAN RIJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 CHAPEL HILL BLVD APT B202
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3183
Mailing Address - Country:US
Mailing Address - Phone:801-634-5841
Mailing Address - Fax:
Practice Address - Street 1:4215 CONVENTION PL
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-0009
Practice Address - Country:US
Practice Address - Phone:509-546-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60924548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist