Provider Demographics
NPI:1700641875
Name:VONDERAHE, APRIL DAWN
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:DAWN
Last Name:VONDERAHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 COPPER CREST DR
Mailing Address - Street 2:
Mailing Address - City:COPPEROPOLIS
Mailing Address - State:CA
Mailing Address - Zip Code:95228-9686
Mailing Address - Country:US
Mailing Address - Phone:765-461-0602
Mailing Address - Fax:
Practice Address - Street 1:800 S LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3635
Practice Address - Country:US
Practice Address - Phone:209-333-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48603225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant