MEDICARE: MRS. KELLY ELIZABETH VAN RIJ L.AC., RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT8620	FL
2	171100000X	Acupuncturist	AP1788	FL

General Provider Information

NPI Number	:	1255546107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY ELIZABETH VAN RIJ L.AC., RPT

Provider Business Mailing Address
First Line	:	454 LEEWAY TRL
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-2563
Country	:	US
Telephone Number	:	386-673-1014
Fax Number	:	386-671-2113

Provider Business Practice Location Address
First Line	:	1450 NORTH HIGHWAY US 1
Second Line	:	SUITE 900
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174
Country	:	US
Telephone Number	:	386-671-2112
Fax Number	:	386-671-2113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	11/14/2017

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Directions to “ MRS. KELLY ELIZABETH VAN RIJ L.AC., RPT” Practice Location

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