Provider Demographics
NPI:1952739674
Name:VANARTSDALEN, VICKI (PTA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:VANARTSDALEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-2601
Mailing Address - Country:US
Mailing Address - Phone:215-837-0473
Mailing Address - Fax:
Practice Address - Street 1:210 6TH AVE
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-2601
Practice Address - Country:US
Practice Address - Phone:215-837-0473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1001181225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant