Provider Demographics
NPI:1316151707
Name:VAN VOLKENBURG, SUSAN W (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:W
Last Name:VAN VOLKENBURG
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 1:150 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4620
Mailing Address - Country:US
Mailing Address - Phone:561-213-7572
Mailing Address - Fax:561-883-7801
Practice Address - Street 1:21065 POWERLINE RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2313
Practice Address - Country:US
Practice Address - Phone:561-883-7800
Practice Address - Fax:561-883-7801
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist