Individual
KENNETH VAN WYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2781 OSBORN DR, LAKE HAVASU CITY, AZ 86406-8629
(928) 505-5552
Mailing address
2781 OSBORN DR, LAKE HAVASU CITY, AZ 86406-8629
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2492
AZ
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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