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General NPI Number Information
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NPI Number | 1366825218
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Entity Type | Individual
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Provider Name | TIFFANY VANDERWEELE DPT
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Gender | Female
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 820 JOHN ST
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City | KALAMAZOO
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State | MI
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Zip | 49001-2870
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Country | US
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Telephone | 269-341-6510
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Fax |
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Provider Business Mailing Address
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Address Line | 1736 GEZON PKWY SW SUITE 100
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City | WYOMING
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State | MI
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Zip | 49519-9526
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Country | US
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501016919
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License Number State | MI
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