Active NPI
Rebecca J Vanduluitgaarden, PT, DPT
- Physical Therapist
- Camden, NY
National Provider Identifier
1720576341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 012995
- Practice address
- 23 Mexico St
Camden, NY 13316-1203 - Phone
- (315) 820-8014
- NPI assigned
- Apr 30, 2018
- Last updated
- Jan 7, 2021
- 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 | 012995 | NY | Primary |
Addresses
Primary practice location
23 Mexico St
Camden, NY 13316-1203
Mailing address
4503 Stoney Brook Rd
Oneida, NY 13421-3715
Phone (315) 289-2558
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012995 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 3 Circles Therapy: OT, PT, SLP Services PLLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Early Intervention Provider Agency
- Camden, NY
- NPI 1952748311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609977600000",
"number": "1720576341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4503 STONEY BROOK RD",
"city": "ONEIDA",
"state": "NY",
"postal_code": "134213715",
"telephone_number": "315-289-2558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 MEXICO ST",
"city": "CAMDEN",
"state": "NY",
"postal_code": "133161203",
"telephone_number": "315-820-8014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDULUITGAARDEN",
"first_name": "REBECCA",
"middle_name": "J",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-30",
"last_updated": "2021-01-07",
"certification_date": "2021-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "012995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camden, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.