Kevin Dat Van, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP050485T Issued in GA

Practice address

875 Mansell Rd Ste H
Roswell, GA 30076-4800

Phone

(678) 821-2170

NPI assigned

Oct 21, 2025

Last updated

Nov 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Rehabilitation Group IncGroup PAC ID 7618341454, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Southeast Rehabilitation Group Inc

  • Physical Therapy Clinic/Center
  • Roswell, GA
  • NPI 1437855830
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1761004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1770450124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 MANSELL RD STE H",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764800",
            "telephone_number": "678-821-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 MANSELL RD STE H",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764800",
            "telephone_number": "678-821-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN",
        "first_name": "KEVIN",
        "middle_name": "DAT",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-10-21",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305217444",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "CP050485T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Renee Van Deventer, MS, NCC
• Mary Katherine Van Heel, PT, DPT
• Christine Elizabeth Van Looy, RN, APRN
• Van Varick Pediatric Physical Therapy
• Elizabeth Van Varick, PT, DPT
• Vanbuskirk Counseling LLC
• Leigh Vanderels
• Laura Lee Vanderheijden, MS, CCC-SLP
• Andrea Reeves Vandervort, OTR
• Chloe Vandiver

• Physical Therapist in Roswell, GA
• Providers in Roswell, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.