Daniel William Van Dyck, PTA

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

PTA 2602 Issued in AR

Practice address

118 Jerry Selby Dr
Crossett, AR 71635-4734

Phone

(870) 364-1534

NPI assigned

Jan 28, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Daniel William Van Dyck Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454025600000",
    "number": "1780041244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 JERRY SELBY DR",
            "city": "CROSSETT",
            "state": "AR",
            "postal_code": "716354734",
            "telephone_number": "870-364-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 JERRY SELBY DR",
            "city": "CROSSETT",
            "state": "AR",
            "postal_code": "716354734",
            "telephone_number": "870-364-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYCK",
        "first_name": "DANIEL",
        "middle_name": "WILLIAM",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-28",
        "last_updated": "2016-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "PTA 2602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIEL",
            "last_name": "VAN DYCK",
            "middle_name": "WILLIAM",
            "prefix": "MR.",
            "credential": "PTA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Skilled Nursing Facility in Crossett, AR
• Providers in Crossett, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; 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.