Provider Demographics
NPI:1801919154
Name:VAN HEMERT TOT DINGSHOF, HENRIETTA (PT)
Entity type:Individual
Prefix:MS
First Name:HENRIETTA
Middle Name:
Last Name:VAN HEMERT TOT DINGSHOF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JETTA
Other - Middle Name:
Other - Last Name:VAN HEMERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:199 SECOND STREET
Mailing Address - Street 2:PO BOX 370606
Mailing Address - City:MONTARA
Mailing Address - State:CA
Mailing Address - Zip Code:94037-0606
Mailing Address - Country:US
Mailing Address - Phone:650-728-3124
Mailing Address - Fax:
Practice Address - Street 1:785 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1992
Practice Address - Country:US
Practice Address - Phone:650-728-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist