Healthcare Provider Details

I. General information

NPI: 1487674503
Provider Name (Legal Business Name): AMANDA VAN DYK D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5061 HASKELL AVE
ENCINO CA
91436-1548
US

IV. Provider business mailing address

5061 HASKELL AVE
ENCINO CA
91436-1548
US

V. Phone/Fax

Practice location:
  • Phone: 310-968-2800
  • Fax:
Mailing address:
  • Phone: 310-968-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number43234
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: