Susanna (Sunel) P Van Der Walt, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

4594 Issued in NM

Practice address

5700 Harper Dr NE Ste 250
Albuquerque, NM 87109-3588

Phone

(505) 828-2273

NPI assigned

Feb 23, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trailhead Pelvic & Visceral Physical Therapy LLC

  • Physical Therapist
  • Los Ranchos de Albuquerque, NM
  • NPI 1023757747
  NPD
• Amistad Family Services Inc

  • Community/Behavioral Health Agency
  • Las Cruces, NM
  • NPI 1558654483
  NPD (past)
• Explorabilities Inc

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Albuquerque, NM
  • NPI 1346210473
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609459200000",
    "number": "1124410519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 ANASAZI TRAILS LOOP",
            "city": "PLACITAS",
            "state": "NM",
            "postal_code": "870438760",
            "telephone_number": "505-639-9937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 HARPER DR NE STE 250",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093588",
            "telephone_number": "505-828-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7609 Northridge Ave NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871093011",
            "country_code": "US",
            "telephone_number": "505-476-0801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7609 Northridge Ave NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871093011",
            "country_code": "US",
            "telephone_number": "505-476-0801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN DER WALT",
        "first_name": "SUSANNA (SUNEL)",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-23",
        "last_updated": "2021-01-01",
        "certification_date": "2021-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NM",
            "license": "4594",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NM",
            "license": "4594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10171568",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "326556",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Van Bastian, DPT
• Julie A Van Buskirk, PA-C
• Lillieth Van Dam
• Victoria Van Dame, OTR/L
• Joyce Van Dellen, CFNP
• Kristine Van Dijck, PT
• Nicole Van Duyn, LCSW
• Dina M Van Dyke, LMHC
• Madelaine E Van Epp, LMFT
• Kailee Van Every

• Pediatric Physical Therapist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Pediatric Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.