Provider Demographics
NPI:1235466822
Name:VANDER VEEN, LAUREN J (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:VANDER VEEN
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 1:180 PEAHI RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5444
Mailing Address - Country:US
Mailing Address - Phone:808-344-8565
Mailing Address - Fax:808-575-9109
Practice Address - Street 1:149 HANA HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:PAIA
Practice Address - State:HI
Practice Address - Zip Code:96779-9745
Practice Address - Country:US
Practice Address - Phone:808-579-9750
Practice Address - Fax:808-579-9751
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist