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General NPI Number Information
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NPI Number | 1215334958
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Entity Type | Individual
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Provider Name | BENJAMIN JOHN VANARENDONK DPT
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Gender | Male
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | COBRA CLINIC VIA PORDENONE 89, BLDG 1466
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City | AVIANO AB
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State | PORDENONE
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Zip | 33089
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Country | IT
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Telephone | 43-430-9060
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Fax |
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Provider Business Mailing Address
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Address Line | COBRA CLINIC VIA PORDENONE 89, BLDG 1466
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City | AVIANO AB
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State | PORDENONE
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Zip | 33089
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Country | IT
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT60468698
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License Number State | WA
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