Provider Demographics
NPI:1528281748
Name:VANHEEL, DOUGLAS R (PT/ATC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:VANHEEL
Suffix:
Gender:M
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39565-8376
Mailing Address - Country:US
Mailing Address - Phone:228-238-9039
Mailing Address - Fax:
Practice Address - Street 1:2541 PASS RD
Practice Address - Street 2:SUITE F
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2106
Practice Address - Country:US
Practice Address - Phone:228-388-1002
Practice Address - Fax:228-388-1006
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3713174400000X
MSAT0391174400000X
ALPTH7331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1033218524OtherGROUP NPI
MS09015077Medicaid
MS09015077Medicaid