MEDICARE: SCOTT W VAN NIEKERK 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
1	225100000X	Physical Therapist	016861-1	NY
2	225100000X	Physical Therapist	020550	NY

General Provider Information

NPI Number	:	1881692309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT W VAN NIEKERK PT

Provider Business Mailing Address
First Line	:	1591 ROUTE 22 BLDG 3
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4025
Country	:	US
Telephone Number	:	845-940-1050
Fax Number	:	845-940-1051

Provider Business Practice Location Address
First Line	:	1591 ROUTE 22
Second Line	:	WHOLISTIC PHYSICAL THERAPY
City	:	BREWSTER
State	:	NY
Zip	:	10509-4026
Country	:	US
Telephone Number	:	845-940-1050
Fax Number	:	845-940-1051

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	05/07/2020

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