Provider Demographics
NPI:1811526296
Name:VANDONGEN, ERIC (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VANDONGEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 STOCKYARD ST APT 201
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1136
Mailing Address - Country:US
Mailing Address - Phone:908-304-8043
Mailing Address - Fax:
Practice Address - Street 1:2004 HAYES ST STE 110
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2648
Practice Address - Country:US
Practice Address - Phone:615-815-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12679225100000X
NJ40QA01685000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist