Provider Demographics
NPI:1992089858
Name:VANDERLUGT, JOEL ERIC (PT , DPT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ERIC
Last Name:VANDERLUGT
Suffix:
Gender:M
Credentials:PT , DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 5300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:616-340-1643
Mailing Address - Fax:
Practice Address - Street 1:9028 N RODGERS DR
Practice Address - Street 2:SUITE J
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316
Practice Address - Country:US
Practice Address - Phone:616-891-0600
Practice Address - Fax:208-489-4300
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist