Provider Demographics
NPI:1972653012
Name:VANDEN HEUVEL, LORE CHRISTINE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LORE
Middle Name:CHRISTINE
Last Name:VANDEN HEUVEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5021
Mailing Address - Country:US
Mailing Address - Phone:925-779-5263
Mailing Address - Fax:
Practice Address - Street 1:3400 DELTA FAIR BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4004
Practice Address - Country:US
Practice Address - Phone:925-779-5263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist