Provider Demographics
NPI:1720347156
Name:VAN KOUWEN, FRANK BERNARDUS (PT)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:BERNARDUS
Last Name:VAN KOUWEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6523
Mailing Address - Country:US
Mailing Address - Phone:352-589-5595
Mailing Address - Fax:352-589-5747
Practice Address - Street 1:443 PLAZA DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6523
Practice Address - Country:US
Practice Address - Phone:352-589-5595
Practice Address - Fax:352-589-5747
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720096720OtherNPI
686515OtherMEDICARE PTAN