MEDICARE: KATHERINE VAN DEN HEUVEL DPT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407250186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE VAN DEN HEUVEL DPT

Provider Business Mailing Address
First Line	:	1644 LINDLEY ST
Second Line	:
City	:	MANGONIA PARK
State	:	FL
Zip	:	33407-2123
Country	:	US
Telephone Number	:	757-580-2947
Fax Number	:

Provider Business Practice Location Address
First Line	:	9897 LAKE WORTH RD STE 203
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2377
Country	:	US
Telephone Number	:	561-331-3636
Fax Number	:

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

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	08/30/2024

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