Provider Demographics
NPI:1134734114
Name:VAN DYCK, SEBASTIAN D (DPT)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:D
Last Name:VAN DYCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2522
Mailing Address - Country:US
Mailing Address - Phone:207-844-4432
Mailing Address - Fax:
Practice Address - Street 1:14 THOMAS POINT RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3911
Practice Address - Country:US
Practice Address - Phone:207-442-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist