MEDICARE: THERESA D VANDECARR PT

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	CP052373T	VA
2	225100000X	Physical Therapist	PT-008687	OH

General Provider Information

NPI Number	:	1982654620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA D VANDECARR PT

Provider Business Mailing Address
First Line	:	5364 ERIN ISLES CT
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-1005
Country	:	US
Telephone Number	:	614-562-4458
Fax Number	:	614-586-4252

Provider Business Practice Location Address
First Line	:	2076 S INDEPENDENCE BLVD STE A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4779
Country	:	US
Telephone Number	:	757-302-4144
Fax Number	:	757-271-9108

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/05/2026

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