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General NPI Number Information
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NPI Number | 1932812674
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Entity Type | Individual
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Provider Name | LILLIAN R VAN GELDEREN
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Gender | Female
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1423 W CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49024-5323
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Country | US
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Telephone | 269-323-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 1653 KENNEDY BLVD
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City | THREE RIVERS
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State | MI
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Zip | 49093
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Country | US
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Telephone | 231-923-8322
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502008525
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License Number State | MI
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