Provider Demographics
NPI:1962661116
Name:WIJNMAALEN, JOHANNES HELMERT (DPT, MBA, MTC)
Entity Type:Individual
Prefix:DR
First Name:JOHANNES
Middle Name:HELMERT
Last Name:WIJNMAALEN
Suffix:
Gender:M
Credentials:DPT, MBA, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 SHORT AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3445
Mailing Address - Country:US
Mailing Address - Phone:727-372-9922
Mailing Address - Fax:727-372-8477
Practice Address - Street 1:2040 SHORT AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3445
Practice Address - Country:US
Practice Address - Phone:727-372-9922
Practice Address - Fax:727-372-8477
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14616225100000X, 2251C2600X, 2251E1200X, 2251N0400X, 2251S0007X, 2251X0800X
PT146162251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCZ216ZMedicare PIN