Basic Information
| Provider Information | |||||||||
| NPI: | 1619018504 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VAN PELT & ASSOCIATES PHYSICAL THERAPY SERVICES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3848 FAU BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613952920 | ||||||||
| FaxNumber: | 5613952960 | ||||||||
| Practice Location | |||||||||
| Address1: | 3848 FAU BLVD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613952920 | ||||||||
| FaxNumber: | 5619978929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | VAN PELT | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5613952920 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Y915V | 01 | FL | BCBS OF FL | OTHER |