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General NPI Number Information
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NPI Number | 1710105267
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Entity Type | Individual
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Provider Name | JEANETTE VAN DUYNE PT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5650 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-7312
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Country | US
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Telephone | 321-264-9331
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Fax |
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Provider Business Mailing Address
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Address Line | 2539 NORMA ST
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City | TITUSVILLE
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State | FL
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Zip | 32780-2845
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Country | US
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Telephone | 321-267-4984
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT18971
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License Number State | FL
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