| Doctor Name: | MR. KOENRAAD J VAN DEN BROECK |
| NPI Number: | 1386686632 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT 12340 |
| Business Practice Address: | 13201 Walsingham Rd Largo, FL - 337743518 |
| Business Phone Number: | 7275937909 |
| Business Fax Number: | 7275937897 |
| Mailing Address: | 222 Sun Vista Ct N, TREASURE ISLAND |
| State: | FL |
| Postal Code: | 337064475 |
| Phone Number: | 7273637329 |
| Fax Number: | |
| NPI Enumeration Date: | 06/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT 12340 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |