Provider Demographics
NPI:1962651059
Name:ZONDERVAN, BARBARA SUE (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUE
Last Name:ZONDERVAN
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 1:1661 GOLDEN RAIN RD
Mailing Address - Street 2:BLDG D, #401
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-4907
Mailing Address - Country:US
Mailing Address - Phone:562-795-6217
Mailing Address - Fax:562-342-9638
Practice Address - Street 1:1661 GOLDEN RAIN RD
Practice Address - Street 2:BLDG D, #401
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-4907
Practice Address - Country:US
Practice Address - Phone:562-795-6217
Practice Address - Fax:562-342-9638
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist