Provider Demographics
NPI:1952504029
Name:VAN SLUYTMAN, RADIKHA (PT)
Entity Type:Individual
Prefix:MS
First Name:RADIKHA
Middle Name:
Last Name:VAN SLUYTMAN
Suffix:
Gender:F
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:PO BOX 16957
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-6957
Mailing Address - Country:US
Mailing Address - Phone:954-473-8633
Mailing Address - Fax:954-473-9460
Practice Address - Street 1:350 NW 84TH AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-473-8633
Practice Address - Fax:954-473-9460
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT20773OtherLICENSE NUMBER