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General NPI Number Information
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NPI Number | 1841200144
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Entity Type | Individual
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Provider Name | MICHEL VAN THIELEN PT, AP, OMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 1430 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4551
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Country | US
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Telephone | 386-274-2090
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Fax | 386-274-7010
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Provider Business Mailing Address
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Address Line | 709 S HARBOR CITY BLVD STE 100
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City | MELBOURNE
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State | FL
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Zip | 32901-1936
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Country | US
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Telephone | 386-295-1051
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2222
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT17909
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License Number State | FL
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