Provider Demographics
NPI:1275342818
Name:VAN DER VLIET, CHRISTINA M (PT)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:M
Last Name:VAN DER VLIET
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2368
Mailing Address - Country:US
Mailing Address - Phone:609-607-0555
Mailing Address - Fax:609-607-0178
Practice Address - Street 1:249 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2368
Practice Address - Country:US
Practice Address - Phone:609-607-0555
Practice Address - Fax:609-607-0178
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02305000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist