MEDICARE: SEAN M VONDERFECHT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	1893	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39676	OTHER	NE	BLUE CROSS

General Provider Information

NPI Number	:	1497820567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN M VONDERFECHT PT

Provider Business Mailing Address
First Line	:	223 E 14TH ST STE 40
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-3240
Country	:	US
Telephone Number	:	402-462-2665
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E 14TH ST STE 40
Second Line	:
City	:	HASTINGS
State	:	NE
Zip	:	68901-3240
Country	:	US
Telephone Number	:	402-462-2665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	03/21/2008

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Directions to “ SEAN M VONDERFECHT PT” Practice Location

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