Provider Demographics
NPI:1144265166
Name:VAN DIJK, ERIK (PT)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:VAN DIJK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2423
Mailing Address - Country:US
Mailing Address - Phone:740-264-5559
Mailing Address - Fax:740-264-5355
Practice Address - Street 1:320 S HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2423
Practice Address - Country:US
Practice Address - Phone:740-264-5559
Practice Address - Fax:740-264-5355
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0848113Medicaid
OH341640963-00OtherWORKERS COM
OHVA0701136Medicare ID - Type Unspecified
OHVA0701135Medicare ID - Type Unspecified
OH0848113Medicaid