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NPI Code Detail

MEDICARE: JEANETTE VAN DUYNE PT

MEDICARE: JEANETTE VAN DUYNE PT
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
1174400000XSpecialistPT18971FL

General Provider Information

NPI Number : 1710105267
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANETTE VAN DUYNE PT
Provider Business Mailing Address
First Line : 2539 NORMA ST
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-2845
Country : US
Telephone Number : 321-267-4984
Fax Number :
Provider Business Practice Location Address
First Line : 5650 S WASHINGTON AVE
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-7312
Country : US
Telephone Number : 321-264-9331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2007
Last Update Date : 07/08/2007

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Directions to “ JEANETTE VAN DUYNE PT” Practice Location

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