Active NPI
Jacqueline Renee Vaneecke, PT
- Physical Therapist
- Royal Oak, MI
National Provider Identifier
1083806145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501008061
- Practice address
- 29968 Woodward Ave
Royal Oak, MI 48073-0908 - Phone
- (248) 541-9121
- Fax
- (248) 541-8386
- NPI assigned
- Aug 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501008061 | MI | Primary |
Addresses
Primary practice location
29968 Woodward Ave
Royal Oak, MI 48073-0908
Mailing address
2168 Gulliver Dr
Troy, MI 48085-1034
Phone (586) 850-5947
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletico LTD | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186963200000",
"number": "1083806145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2168 GULLIVER DR",
"city": "TROY",
"state": "MI",
"postal_code": "480851034",
"telephone_number": "586-850-5947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29968 WOODWARD AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480730908",
"telephone_number": "248-541-9121",
"fax_number": "248-541-8386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANEECKE",
"first_name": "JACQUELINE RENEE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-13",
"last_updated": "2007-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501008061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.