MEDICARE: MS. HENRIETTA VAN HEMERT TOT DINGSHOF PT

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	PT18954	CA

General Provider Information

NPI Number	:	1801919154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HENRIETTA VAN HEMERT TOT DINGSHOF PT

Provider Business Mailing Address
First Line	:	199 SECOND STREET
Second Line	:	PO BOX 370606
City	:	MONTARA
State	:	CA
Zip	:	94037-0606
Country	:	US
Telephone Number	:	650-728-3124
Fax Number	:

Provider Business Practice Location Address
First Line	:	785 MAIN ST
Second Line	:	SUITE A
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1992
Country	:	US
Telephone Number	:	650-728-3124
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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