Provider Demographics
NPI:1982776571
Name:VANDERSANDEN, JEAN TERESE (PT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:TERESE
Last Name:VANDERSANDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 175TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4610
Mailing Address - Country:US
Mailing Address - Phone:312-238-2163
Mailing Address - Fax:312-238-2155
Practice Address - Street 1:1055 175TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4610
Practice Address - Country:US
Practice Address - Phone:312-238-2163
Practice Address - Fax:312-238-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist