Provider Demographics
NPI:1427200468
Name:VANDYKE, RON
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1672
Mailing Address - Country:US
Mailing Address - Phone:605-622-5000
Mailing Address - Fax:605-622-5255
Practice Address - Street 1:721 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4503
Practice Address - Country:US
Practice Address - Phone:605-622-4055
Practice Address - Fax:605-622-5255
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist