Provider Demographics
NPI:1639586423
Name:VANDENMEERENDONK, JACOB (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:VANDENMEERENDONK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40680 CALIFORNIA OAKS RD
Mailing Address - Street 2:STE 2A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5755
Mailing Address - Country:US
Mailing Address - Phone:951-894-4800
Mailing Address - Fax:951-894-4804
Practice Address - Street 1:40680 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5753
Practice Address - Country:US
Practice Address - Phone:951-894-4800
Practice Address - Fax:951-894-4804
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic