Active NPI
Nicole M Van Leeuwen, PTA
- Physical Therapy Assistant
- Royal Palm Beach, FL
National Provider Identifier
1912168725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 20818
- Practice address
- 1419 Denlow LN
Royal Palm Beach, FL 33411-4013 - Phone
- (561) 762-0637
- Fax
- (561) 357-5884
- NPI assigned
- Jun 24, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA 20818 | FL | Primary |
Addresses
Primary practice location
1419 Denlow LN
Royal Palm Beach, FL 33411-4013
Mailing address
1419 Denlow LN
Royal Palm Beach, FL 33411-4013
Phone (561) 762-0637
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA 20818 | Other | FL | AMERICAN PHYSICAL THERAPY ASSOCIATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA 20818 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214265600000",
"number": "1912168725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1419 DENLOW LN",
"city": "ROYAL PALM BEACH",
"state": "FL",
"postal_code": "334114013",
"telephone_number": "561-762-0637",
"fax_number": "561-357-5884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1419 DENLOW LN",
"city": "ROYAL PALM BEACH",
"state": "FL",
"postal_code": "334114013",
"telephone_number": "561-762-0637",
"fax_number": "561-357-5884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN LEEUWEN",
"first_name": "NICOLE",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-24",
"last_updated": "2008-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA 20818",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN PHYSICAL THERAPY ASSOCIATION",
"identifier": "PTA 20818",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Royal Palm Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.