Provider Demographics
NPI:1679743892
Name:VANDYKE, LINDA M (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:VAN DYKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1471 GETZ RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5725
Mailing Address - Country:US
Mailing Address - Phone:231-798-3914
Mailing Address - Fax:
Practice Address - Street 1:1471 GETZ RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-5725
Practice Address - Country:US
Practice Address - Phone:231-798-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501000766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist