MEDICARE: STIJN DHESPEEL DPT, ATC

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	PT 26682	FL

General Provider Information

NPI Number	:	1730429291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STIJN DHESPEEL DPT, ATC

Provider Business Mailing Address
First Line	:	6017 CYPRESS LN
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-3836
Country	:	US
Telephone Number	:	941-586-1685
Fax Number	:

Provider Business Practice Location Address
First Line	:	6017 CYPRESS LN
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-3836
Country	:	US
Telephone Number	:	941-586-1685
Fax Number	:

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

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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