Provider Demographics
NPI:1497820567
Name:VONDERFECHT, SEAN M (PT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:VONDERFECHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 14TH ST STE 40
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3240
Mailing Address - Country:US
Mailing Address - Phone:402-462-2665
Mailing Address - Fax:
Practice Address - Street 1:223 E 14TH ST STE 40
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3240
Practice Address - Country:US
Practice Address - Phone:402-462-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39676OtherBLUE CROSS
NE276354Medicare PIN