Provider Demographics
NPI:1588694087
Name:VAN SCHERPENSEEL, ANTONIUS JOHANNES (PT, MTC, OCS)
Entity type:Individual
Prefix:
First Name:ANTONIUS
Middle Name:JOHANNES
Last Name:VAN SCHERPENSEEL
Suffix:
Gender:M
Credentials:PT, MTC, OCS
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Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:1438 HIGHWAY 16 W STE C
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2096
Practice Address - Country:US
Practice Address - Phone:770-233-0350
Practice Address - Fax:770-233-0370
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT002212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA539457825AMedicaid
GA539457825AMedicaid
GA539457825AMedicaid