Provider Demographics
NPI:1700996360
Name:CLAESSENS, JOANNES MARIA (PT)
Entity Type:Individual
Prefix:MR
First Name:JOANNES
Middle Name:MARIA
Last Name:CLAESSENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JON
Other - Middle Name:MARIA
Other - Last Name:CLAESSENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:770 KEENELAND PIKE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3951
Mailing Address - Country:US
Mailing Address - Phone:407-321-8833
Mailing Address - Fax:407-322-8866
Practice Address - Street 1:770 KEENELAND PIKE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3951
Practice Address - Country:US
Practice Address - Phone:407-321-8833
Practice Address - Fax:407-322-8866
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3434YMedicare ID - Type UnspecifiedPHYSICAL THERAPIST