Provider Demographics
NPI:1033421672
Name:RADEMAKER, CARA (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:RADEMAKER
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:VINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, DPT
Mailing Address - Street 1:550 SAINT CHARLES DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3951
Mailing Address - Country:US
Mailing Address - Phone:805-777-1023
Mailing Address - Fax:805-777-3496
Practice Address - Street 1:550 SAINT CHARLES DR
Practice Address - Street 2:SUITE #100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3951
Practice Address - Country:US
Practice Address - Phone:805-777-1023
Practice Address - Fax:805-777-3496
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL433ZOtherMEDICARE PTAN