Provider Demographics
NPI:1265488753
Name:VANDERWOUDE, BARBARA MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MARIE
Last Name:VANDERWOUDE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:MARIE
Other - Last Name:NAZARKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 DEANNA DR STE C
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2402
Practice Address - Country:US
Practice Address - Phone:219-696-0988
Practice Address - Fax:219-696-0989
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004131A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM55585021Medicare PIN
IN487210017Medicare PIN
IN000000324516OtherANTHEM MBWOUDE
IN214690CMedicare ID - Type UnspecifiedPART B GROUP MEMBER
IN000000092322OtherANTHEM APT PLUS
IN650015335Medicare ID - Type UnspecifiedRR MEDICARE - APT PLUS
IN214710FMedicare ID - Type UnspecifiedPART B GROUP MEMBER
INP00274228Medicare ID - Type UnspecifiedRR MED - 1ST AID PLUS