Provider Demographics
NPI:1134441272
Name:VANVLIET, DENISE (LMT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:VANVLIET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N MAIN ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9146
Mailing Address - Country:US
Mailing Address - Phone:630-365-9343
Mailing Address - Fax:
Practice Address - Street 1:525 N MAIN ST
Practice Address - Street 2:SUITE 28
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-9146
Practice Address - Country:US
Practice Address - Phone:630-365-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.009816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist