Provider Demographics
NPI:1497290464
Name:VANBEMDEN, ANGIE (PHD, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:
Last Name:VANBEMDEN
Suffix:
Gender:F
Credentials:PHD, ATC, CSCS
Other - Prefix:DR
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:BOTTO-VAN BEMDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1004 AVOCADO ISLE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1338
Mailing Address - Country:US
Mailing Address - Phone:954-763-2670
Mailing Address - Fax:
Practice Address - Street 1:1004 AVOCADO ISLE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1338
Practice Address - Country:US
Practice Address - Phone:954-763-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 16262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer