Provider Demographics
NPI:1841200144
Name:VAN THIELEN, MICHEL (PT, AP, OMD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:VAN THIELEN
Suffix:
Gender:M
Credentials:PT, AP, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S HARBOR CITY BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1936
Mailing Address - Country:US
Mailing Address - Phone:386-295-1051
Mailing Address - Fax:
Practice Address - Street 1:1430 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4551
Practice Address - Country:US
Practice Address - Phone:386-274-2090
Practice Address - Fax:386-274-7010
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2222171100000X
FLPT17909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist