Individual
STEVEN LEE VAN GENDEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1158
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46778
SANFORD
SD
01
—
4994487
WELLMARK
—
05
—
5834960
—
SD
01
—
P00278969
MEDICARE RAILROAD
SD
01
—
PT1158
DAKOTACARE
SD
Enumeration date
03/10/2006
Last updated
11/16/2012
Update your record
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