Individual
MR. RUSSELL ALLEN VANDE VEGTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4510 VIEWRIDGE AVE, SAN DIEGO, CA 92123-1637
(858) 694-4922
Mailing address
2509 ARNOTT ST, SAN DIEGO, CA 92110-1152
(619) 276-7980
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
14066
CA
Other
Enumeration date
06/25/2007
Last updated
11/19/2021
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