Provider Demographics
NPI:1700429099
Name:VONDERHAAR PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:VONDERHAAR PHYSICAL THERAPY, LLC
Other - Org Name:AFFILIATE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:VONDERHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:330-697-8327
Mailing Address - Street 1:67 W DUNEDIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4001
Mailing Address - Country:US
Mailing Address - Phone:330-697-8327
Mailing Address - Fax:
Practice Address - Street 1:880 KINNEAR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1443
Practice Address - Country:US
Practice Address - Phone:330-697-8327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-20
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy