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Individual

BRAD W VANDEVELDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
972 BROOK FOREST AVE, SHOREWOOD, IL 60404-8807
(815) 439-4938
(815) 439-7816
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-016543
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P01019766
MEDICARE RAILROAD
IL
Enumeration date
08/04/2008
Last updated
10/23/2013
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