Provider Demographics
NPI:1699281162
Name:VAN DUSEN PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:VAN DUSEN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-632-1280
Mailing Address - Street 1:851 GRAY AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3652
Mailing Address - Country:US
Mailing Address - Phone:530-671-8378
Mailing Address - Fax:530-660-8451
Practice Address - Street 1:851 GRAY AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3652
Practice Address - Country:US
Practice Address - Phone:530-671-8378
Practice Address - Fax:530-660-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24994261QP2000X
CAPT293470261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy