Basic Information
| Provider Information | |||||||||
| NPI: | 1528281748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANHEEL | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PT/ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10521 DOGWOOD DR | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395658376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282389039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2541 PASS RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395312106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283881002 | ||||||||
| FaxNumber: | 2283881006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 11/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT3713 | MS | Y | Other Service Providers | Specialist | 174400000X | AT0391 | MS | N | Other Service Providers | Specialist | 225100000X | PTH7331 | AL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1033218524 | 01 | MS | GROUP NPI | OTHER | 09015077 | 05 | MS | MEDICAID |