Individual
GARY MITCHELL VAN DERVEER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3935 E GREENWAY RD APT 205, PHOENIX, AZ 85032-4671
(602) 497-7422
Mailing address
GARY M. VAN DERVEER, 3935 E. GREENWAY RD APT. 205, PHOENIX, AZ 85032-4671
(602) 497-7422
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-14602
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT-14602
AZ STATE MASSAGE BOARD
AZ
Enumeration date
07/07/2021
Last updated
07/07/2021
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