MEDICARE: MR. STEVE JAMES VANDENBERG 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	5848024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41660	OTHER	WI	SECURITY HEALTH

General Provider Information

NPI Number	:	1649221524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVE JAMES VANDENBERG MPT

Provider Business Mailing Address
First Line	:	24014 W RENWICK RD STE F
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60544-8708
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

Provider Business Practice Location Address
First Line	:	213016 LEGION STREET
Second Line	:
City	:	STRATFORD
State	:	WI
Zip	:	54484-5028
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	05/16/2022

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