Provider Demographics
NPI:1588221931
Name:VANDUSEN, JANET BETH (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:BETH
Last Name:VANDUSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 RUSH CREEK DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8720
Mailing Address - Country:US
Mailing Address - Phone:616-583-0420
Mailing Address - Fax:
Practice Address - Street 1:3101 PRAIRIE ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2047
Practice Address - Country:US
Practice Address - Phone:616-531-9973
Practice Address - Fax:616-531-5577
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty