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NPI Code Detail

MEDICARE: ANDREW VAN LEUVEN DPT

MEDICARE: ANDREW VAN LEUVEN 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
1225100000XPhysical TherapistPT 40467CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB210572OTHERCAMEDICARE PTAN

General Provider Information

NPI Number : 1679994776
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW VAN LEUVEN DPT
Provider Business Mailing Address
First Line : 1600 DOVE ST STE 100
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-2438
Country : US
Telephone Number : 949-502-3388
Fax Number : 949-502-3304
Provider Business Practice Location Address
First Line : 1600 DOVE ST STE 100
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-2438
Country : US
Telephone Number : 949-502-3388
Fax Number : 949-502-3304
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2013
Last Update Date : 12/10/2018

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Directions to “ ANDREW VAN LEUVEN DPT” Practice Location

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