MEDICARE: JASMINE VANDYKE PT, DPT

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	40216	CA
2	225100000X	Physical Therapist	5501016009	MI
3	225100000X	Physical Therapist	P15974	NC
4	225100000X	Physical Therapist	9367	SC

General Provider Information

NPI Number	:	1912321134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE VANDYKE PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 CALHOUN MEMORIAL HWY STE P
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-3682
Country	:	US
Telephone Number	:	864-671-6162
Fax Number	:

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

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	04/10/2025

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