MEDICARE: MR. RAYMOND VAN KUIJK 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	PT0006345	FL

General Provider Information

NPI Number	:	1841268356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND VAN KUIJK P.T.

Provider Business Mailing Address
First Line	:	664 SEVERS LNDG
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6243
Country	:	US
Telephone Number	:	727-785-0016
Fax Number	:

Provider Business Practice Location Address
First Line	:	664 SEVERS LNDG
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6243
Country	:	US
Telephone Number	:	727-785-0016
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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