Basic Information
| Provider Information | |||||||||
| NPI: | 1629203633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN BOCKEL | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7643 MERASTONE LN NE | ||||||||
| Address2: | A-203 | ||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983118834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372589870 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 CLARE AVE | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603773951 | ||||||||
| FaxNumber: | 3603775443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2009 | ||||||||
| LastUpdateDate: | 05/19/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | P160046920 | WA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.