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General NPI Number Information
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NPI Number | 1841029337
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Entity Type | Individual
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Provider Name | CASEY VANDENBARK DPT
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Gender | Female
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 6542 SE LAKE RD
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City | MILWAUKIE
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State | OR
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Zip | 97222-2244
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Country | US
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Telephone | 503-427-0118
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Fax |
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Provider Business Mailing Address
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Address Line | N8679 LAKESHORE DR
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City | FOND DU LAC
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State | WI
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Zip | 54937-1727
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Country | US
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Telephone | 502-287-7452
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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 | 008901
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License Number State | KY
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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 | 65896
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License Number State | OR
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