Provider Demographics
NPI:1871151787
Name:VANWERKHOVEN, COLIN PHILIP (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:PHILIP
Last Name:VANWERKHOVEN
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6994 ALABASTER CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7401
Mailing Address - Country:US
Mailing Address - Phone:301-712-6143
Mailing Address - Fax:
Practice Address - Street 1:11270 PEPPER RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1202
Practice Address - Country:US
Practice Address - Phone:301-712-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist