Vandeventer, Jason R

Vandeventer, Jason R is an individual health care provider with primary practice located at 719 S Rogers St , Bloomington IN 47403-2335. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Vandeventer, Jason R can be contacted via phone (812) 323-4475.

Contact Information

Primary practice address
719 S Rogers St Bloomington IN 47403-2335
Phone: (812) 323-4475
Fax: (812) 323-4478
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 05007082A Indiana

Profile Details

NPI number 1205831070
LBN Legal business name Vandeventer, Jason R
Credentials Master of Physical Therapy (MPT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Sep 26th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205831070 NPPES
Indiana MEDICAID 200363990

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