Healthcare Provider Details

I. General information

NPI: 1619018504
Provider Name (Legal Business Name): VAN PELT & ASSOCIATES PHYSICAL THERAPY SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 FAU BLVD STE 105
BOCA RATON FL
33431-6437
US

IV. Provider business mailing address

3848 FAU BLVD STE 105
BOCA RATON FL
33431-6437
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-2920
  • Fax: 561-997-8929
Mailing address:
  • Phone: 561-395-2920
  • Fax: 561-395-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANA M VAN PELT
Title or Position: PRESIDENT
Credential: PT
Phone: 561-395-2920