Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TPTA000374 | PA |
NPI | 1013390442 |
---|---|
Provider Name | Lindy Vanderbogart |
First Address | Lansdale, PA 19446-5211 |
Second Address | Lansdale, PA 19446-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 02/07/2015 |