Provider Demographics
NPI:1982654620
Name:VANDECARR, THERESA DOROTHY (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DOROTHY
Last Name:VANDECARR
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 1:5364 ERIN ISLES CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1005
Mailing Address - Country:US
Mailing Address - Phone:614-562-4458
Mailing Address - Fax:614-586-4252
Practice Address - Street 1:5364 ERIN ISLES CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1005
Practice Address - Country:US
Practice Address - Phone:614-562-4458
Practice Address - Fax:614-586-4252
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-008687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist