Provider Demographics
NPI:1184371171
Name:VANDERVEER, BROOKLYN HOPE (LPTA)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:HOPE
Last Name:VANDERVEER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 DONALD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2830
Mailing Address - Country:US
Mailing Address - Phone:540-319-3662
Mailing Address - Fax:
Practice Address - Street 1:205 DONALD LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2830
Practice Address - Country:US
Practice Address - Phone:540-319-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604806225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant