MEDICARE: MR. JOHN M VONDRUSKA MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305005881	VA

General Provider Information

NPI Number	:	1083603963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN M VONDRUSKA MPT

Provider Business Mailing Address
First Line	:	18TH MEDCOM ATTN DCCS-QM (CREDENTIALS)
Second Line	:
City	:	APO
State	:	AP
Zip	:	96205-0054
Country	:	KR
Telephone Number	:	01182279166027
Fax Number	:	01182279178110

Provider Business Practice Location Address
First Line	:	121 G.H. PHYSICAL THERAPY CLINIC
Second Line	:
City	:	APO
State	:	AP
Zip	:	96205-0054
Country	:	KR
Telephone Number	:	01182279175001
Fax Number	:	01182279173068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/21/2022

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Directions to “ MR. JOHN M VONDRUSKA MPT” Practice Location

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