Provider Demographics
NPI:1497137434
Name:VANDOORN, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:VANDOORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29840 STATE HIGHWAY 27
Mailing Address - Street 2:BOX 362
Mailing Address - City:HOLCOMBE
Mailing Address - State:WI
Mailing Address - Zip Code:54745-8798
Mailing Address - Country:US
Mailing Address - Phone:507-458-7864
Mailing Address - Fax:
Practice Address - Street 1:29840 STATE HIGHWAY 27
Practice Address - Street 2:BOX 362
Practice Address - City:HOLCOMBE
Practice Address - State:WI
Practice Address - Zip Code:54745-8798
Practice Address - Country:US
Practice Address - Phone:507-458-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1078-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant