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General NPI Number Information
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NPI Number | 1316492135
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Entity Type | Individual
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Provider Name | ANN VAN HERCK P.T.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 1901 MASON AVE STE 105
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City | DAYTONA BEACH
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State | FL
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Zip | 32117
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Country | US
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Telephone | 386-238-9074
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Fax | 386-238-9075
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Provider Business Mailing Address
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Address Line | 1920 BAYTREE CT
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City | PORT ORANGE
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State | FL
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Zip | 32128-3747
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Country | US
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Telephone | 386-238-9074
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Fax | 386-238-9075
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 16029
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License Number State | FL
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