Provider Demographics
NPI:1447016126
Name:VAN PUTTEN, DOUGLAS MILTON (DPT)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MILTON
Last Name:VAN PUTTEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 ALTA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7336
Mailing Address - Country:US
Mailing Address - Phone:219-363-2209
Mailing Address - Fax:
Practice Address - Street 1:25915 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3813
Practice Address - Country:US
Practice Address - Phone:909-686-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3056062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic