Provider Demographics
NPI:1588484042
Name:VAN LOON, JOSE (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:VAN LOON
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:VAN LOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3167
Mailing Address - Country:US
Mailing Address - Phone:619-482-3000
Mailing Address - Fax:619-604-6789
Practice Address - Street 1:3400 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3167
Practice Address - Country:US
Practice Address - Phone:619-482-3000
Practice Address - Fax:619-604-6789
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist