Provider Demographics
NPI:1700871753
Name:VAN DOORNE, ERIK T (DPT)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:T
Last Name:VAN DOORNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 PENNSYLVANIA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1332
Mailing Address - Country:US
Mailing Address - Phone:302-888-2551
Mailing Address - Fax:302-888-2571
Practice Address - Street 1:2323 PENNSYLVANIA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1332
Practice Address - Country:US
Practice Address - Phone:302-888-2551
Practice Address - Fax:302-888-2571
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00A624M80Medicare ID - Type UnspecifiedMEDICARE RENDERING NUMBER