Provider Demographics
NPI:1083050975
Name:VANDAMME, KATHRYN Y (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:Y
Last Name:VANDAMME
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 1:130 W 56TH ST
Mailing Address - Street 2:SUITE 6M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3962
Mailing Address - Country:US
Mailing Address - Phone:574-386-0433
Mailing Address - Fax:212-246-3701
Practice Address - Street 1:130 W 56TH ST
Practice Address - Street 2:SUITE 6M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3962
Practice Address - Country:US
Practice Address - Phone:574-386-0433
Practice Address - Fax:212-246-3701
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0329582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic