Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 4228 | OK |
NPI | 1689186306 |
---|---|
Provider Name | Joseph Benjamin Vandaveer |
First Address | Lindsay, OK 73052-4414 |
Second Address | Lindsay, OK 73052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2017 |
Last Update Date | 03/11/2017 |