MEDICARE: BARBARA MARIE VANDERWOUDE MSPT

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	05004131A	IN

General Provider Information

NPI Number	:	1265488753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA MARIE VANDERWOUDE MSPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 DEANNA DR STE C
Second Line	:
City	:	LOWELL
State	:	IN
Zip	:	46356-2402
Country	:	US
Telephone Number	:	219-696-0988
Fax Number	:	219-696-0989

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	10/18/2023

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