Individual
MR. JOHN MARK VAN EYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
6870
NC
225100000X
Physical Therapist
Primary
7894
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080448
—
AZ
05
—
89104064
—
NM
Enumeration date
11/24/2006
Last updated
08/17/2021
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