Provider Demographics
NPI:1366940363
Name:VAN DAELEN-DENEN, WILHELMINA GERARDA (PT)
Entity type:Individual
Prefix:
First Name:WILHELMINA
Middle Name:GERARDA
Last Name:VAN DAELEN-DENEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5769 ERLANGER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3801
Mailing Address - Country:US
Mailing Address - Phone:858-558-7406
Mailing Address - Fax:
Practice Address - Street 1:3535 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1520
Practice Address - Country:US
Practice Address - Phone:760-436-8900
Practice Address - Fax:760-436-0460
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist