Organization
DEPARTMENT OF VETERAN AFFAIRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM D VANDERBOSCH (PHYSICAL THERAPIST)
(260) 426-5431
Entity
Organization
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
05002316A
IN
Other
Enumeration date
12/08/2010
Last updated
12/08/2010
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