Provider Demographics
NPI:1295525442
Name:VAN DUSEN, MICHELLE LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:VAN DUSEN
Suffix:
Gender:F
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 1:3454 ZAFARANO DR STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2667
Mailing Address - Country:US
Mailing Address - Phone:505-216-5008
Mailing Address - Fax:
Practice Address - Street 1:3454 ZAFARANO DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2667
Practice Address - Country:US
Practice Address - Phone:505-216-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT-2024-0343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist