| Doctor Name: | MR. JOHN VAN KOETSVELD |
| NPI Number: | 1770611063 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPT |
| License Number: | 005535 |
| Business Practice Address: | 100 Grand St Physical Medicine Department New Britain, CT - 060522016 |
| Business Phone Number: | 8602245121 |
| Business Fax Number: | |
| Mailing Address: | 178 Barkledge Dr, NEWINGTON |
| State: | CT |
| Postal Code: | 061112255 |
| Phone Number: | 8607485380 |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2007 |
| NPI Last Update Date: | 01/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251S0007X |
| License Number: | 005535 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Sports |
| Taxonomy Definition: | |