Provider Demographics
NPI:1982663373
Name:VANDER ZANDEN, JAIME (DPT)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:
Last Name:VANDER ZANDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:5601 W MONEE MANHATTAN RD STE 115
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-8866
Practice Address - Country:US
Practice Address - Phone:708-314-7761
Practice Address - Fax:708-314-7762
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010208A225100000X
IL070-017591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01011167OtherMEDICARE RR
INP01011167OtherMEDICARE RR