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General NPI Number Information
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NPI Number | 1740944925
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Entity Type | Individual
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Provider Name | COURTNEY VIOLET VANDERMAY DPT
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 2268 N LAKE SHORE DR STE 106
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City | ROCKWALL
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State | TX
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Zip | 75087-0280
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Country | US
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Telephone | 973-979-6577
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Fax |
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Provider Business Mailing Address
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Address Line | 93 LENOX RD
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City | WAYNE
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State | NJ
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Zip | 07470-5539
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Country | US
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Telephone | 201-790-3697
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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 | LPT-32248
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14700
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P20807
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02047300
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 26167
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1374080
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License Number State | TX
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