Provider Demographics
NPI:1245575414
Name:VANDERWERFF, ADRIANUS MATHIAS (PTA)
Entity type:Individual
Prefix:MR
First Name:ADRIANUS
Middle Name:MATHIAS
Last Name:VANDERWERFF
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 BODESON CT
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9596
Mailing Address - Country:US
Mailing Address - Phone:916-996-8459
Mailing Address - Fax:
Practice Address - Street 1:469 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4710
Practice Address - Country:US
Practice Address - Phone:916-996-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6812225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT 6812OtherPHYSICAL THERAPIST ASSISTANT