MEDICARE: MR. WOUTER VANDERHORST P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0007949	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396740890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WOUTER VANDERHORST P.T.

Provider Business Mailing Address
First Line	:	2033 LONG BRANCH LN
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33760-1960
Country	:	US
Telephone Number	:	727-524-6162
Fax Number	:	727-536-6006

Provider Business Practice Location Address
First Line	:	14141 46TH N ST 1202
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33762-3860
Country	:	US
Telephone Number	:	727-535-6746
Fax Number	:	727-536-6006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/28/2016

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