Provider Demographics
NPI:1316159189
Name:VANDERVEEN, JULIE L (PT)
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:L
Last Name:VANDERVEEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 S MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3334
Mailing Address - Country:US
Mailing Address - Phone:417-569-9721
Mailing Address - Fax:
Practice Address - Street 1:4566 ORANGE BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9104
Practice Address - Country:US
Practice Address - Phone:877-896-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003000090225100000X
TX1168013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist