Provider Demographics
NPI:1376159129
Name:VANDENBERGH, TAMARA J (LMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:VANDENBERGH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 DOUGLAS CT
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9414
Mailing Address - Country:US
Mailing Address - Phone:608-279-7837
Mailing Address - Fax:
Practice Address - Street 1:101 S JONES ST
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:WI
Practice Address - Zip Code:53507-9801
Practice Address - Country:US
Practice Address - Phone:608-279-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist