Healthcare Provider Details

I. General information

NPI: 1821905126
Provider Name (Legal Business Name): VALERIE ANNETTE VAN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SAINT JOSEPH AVE
BERRIEN SPRINGS MI
49103-1583
US

IV. Provider business mailing address

6050 POKAGON RD
BERRIEN SPRINGS MI
49103-1555
US

V. Phone/Fax

Practice location:
  • Phone: 269-471-7725
  • Fax:
Mailing address:
  • Phone: 269-471-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5501004556
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: