Individual
GERALD (GERRY) C VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6193 SOQUEL DR, APTOS, CA 95003-3116
(831) 462-1212
(831) 462-1221
Mailing address
6193 SOQUEL DR, APTOS, CA 95003-3116
(831) 462-1212
(831) 462-1221
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
PT13181
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650009364
RAILROAD MEDICARE
CA
01
—
770393462
BLUE CROSS
CA
05
—
PT0131810
—
CA
01
—
ZZZ45601Z
BLUE SHIELD
CA
Enumeration date
05/31/2006
Last updated
08/19/2013
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