Provider Demographics
NPI:1093784134
Name:VANDER SCHALIE, KURT EDWARD (PT ATC)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:EDWARD
Last Name:VANDER SCHALIE
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 BUSH ST STE C-1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3048
Mailing Address - Country:US
Mailing Address - Phone:415-476-8187
Mailing Address - Fax:415-353-9554
Practice Address - Street 1:2655 BUSH ST STE C-1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-476-8187
Practice Address - Fax:415-353-9554
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870711225100000X
CAPT27832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist