Provider Demographics
NPI:1881692309
Name:VAN NIEKERK, SCOTT W (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:VAN NIEKERK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 ROUTE 22 BLDG 3
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4025
Mailing Address - Country:US
Mailing Address - Phone:845-940-1050
Mailing Address - Fax:845-940-1051
Practice Address - Street 1:1591 ROUTE 22
Practice Address - Street 2:WHOLISTIC PHYSICAL THERAPY
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4026
Practice Address - Country:US
Practice Address - Phone:845-940-1050
Practice Address - Fax:845-940-1051
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016861-1225100000X
NY020550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQA0171Medicare PIN