Provider Demographics
NPI:1811556913
Name:VANDERVOORT, JACOB DEHN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DEHN
Last Name:VANDERVOORT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 COLUMBINE CIR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-9075
Mailing Address - Country:US
Mailing Address - Phone:785-547-7025
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE STE G200
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2934
Practice Address - Country:US
Practice Address - Phone:785-539-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06138208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation