Provider Demographics
NPI:1861848020
Name:VAN GELDER, TERRY JOHN (LMT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:JOHN
Last Name:VAN GELDER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 VANDENBERG AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1743
Mailing Address - Country:US
Mailing Address - Phone:402-880-0325
Mailing Address - Fax:
Practice Address - Street 1:1216 HOWARD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2819
Practice Address - Country:US
Practice Address - Phone:402-880-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist