Healthcare Provider Details

I. General information

NPI: 1679056998
Provider Name (Legal Business Name): PHILLIP VANPELT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PHILLIP S VAN PELT

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 10TH ST NE
WASHINGTON DC
20017-1820
US

IV. Provider business mailing address

PO BOX 419666
BOSTON MA
02241-9666
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-0358
  • Fax:
Mailing address:
  • Phone: 410-970-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27141
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: