Provider Demographics
NPI:1770611063
Name:VAN KOETSVELD, ERNST JOHN (DPT)
Entity type:Individual
Prefix:MR
First Name:ERNST
Middle Name:JOHN
Last Name:VAN KOETSVELD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:ERNST
Other - Middle Name:JOHN
Other - Last Name:VAN KOETSVELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT, OCS, CCI
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:703-933-0038
Mailing Address - Fax:703-933-0199
Practice Address - Street 1:2800 S SHIRLINGTON RD STE 510
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3605
Practice Address - Country:US
Practice Address - Phone:703-933-0038
Practice Address - Fax:703-933-0199
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005535225100000X, 2251S0007X, 2251X0800X
VA2305209358225100000X, 2251X0800X
MDN29452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports