Matthew Vandendaele, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2021048375 Issued in MO

Practice address

6403 N Prospect Ave Ste 450
Gladstone, MO 64119-1545

Phone

(816) 656-3698

Fax

(816) 368-9488

NPI assigned

Sep 10, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Group practices

Fit Muscle and Joint Clinic LLCGroup PAC ID 5991935579, 54 clinicians

Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Fit Muscle & Joint Clinic LLC

  • Rehabilitation Chiropractor
  • Lees Summit, MO
  • NPI 1801350921

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Athletico LTD

  • Physical Therapist
  • Liberty, MO
  • NPI 1114449857
  Medicare reassignment Care Compare group NPD (past)
• Fit Muscle & Joint Clinic LLC

  • Rehabilitation Chiropractor
  • Shawnee, KS
  • NPI 1093088320

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1417626516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6403 N PROSPECT AVE STE 450",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641191545",
            "telephone_number": "816-656-3698",
            "fax_number": "816-368-9488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 N Dean Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Raymore",
            "state": "MO",
            "postal_code": "640838398",
            "country_code": "US",
            "telephone_number": "816-441-5656",
            "fax_number": "913-745-4352",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1860 N Church Rd",
            "address_purpose": "LOCATION",
            "city": "Liberty",
            "state": "MO",
            "postal_code": "640687179",
            "country_code": "US",
            "telephone_number": "816-368-8226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDENDAELE",
        "first_name": "MATTHEW",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-10",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-06898",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2021048375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Gladstone, MO
• Providers in Gladstone, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.