Provider Demographics
NPI:1912078841
Name:VANVOLKENBURG, DON (PT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:
Last Name:VANVOLKENBURG
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 HEMBREE RD
Mailing Address - Street 2:SUITE 200D
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5720
Mailing Address - Country:US
Mailing Address - Phone:770-772-5540
Mailing Address - Fax:770-772-6541
Practice Address - Street 1:1285 HEMBREE RD
Practice Address - Street 2:SUITE 200D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5720
Practice Address - Country:US
Practice Address - Phone:770-772-5540
Practice Address - Fax:770-772-6541
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist