Jordan Vandyck, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

15231-24 Issued in WI

Practice address

5764 S 108TH St
Hales Corners, WI 53130-1947

Phone

(414) 400-7110

Fax

(414) 400-7112

NPI assigned

Dec 9, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aretas02 LLCGroup PAC ID 3870951882, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Aretas02, LLC

  • Physical Therapist
  • Hales Corners, WI
  • NPI 1962199307
  Medicare reassignment Care Compare group NPD
• Team Rehabilitation Services, LLC

  • Physical Therapist
  • Menomonee Falls, WI
  • NPI 1144990490
  Medicare reassignment NPD
• Team Rehabilitation Services, LLC

  • Physical Therapist
  • Marietta, GA
  • NPI 1508538158
  NPD

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1871199471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5764 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301947",
            "telephone_number": "414-400-7110",
            "fax_number": "414-400-7112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5764 S 108TH ST",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301947",
            "telephone_number": "414-400-7110",
            "fax_number": "414-400-7112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDYCK",
        "first_name": "JORDAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-09",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "15231-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Francis Timmer, M.S.W.
• Jennifer Marie Tralongo, OTR
• Susan Tubic
• Cassandra Ann Van Kleunen, D.D.S.
• Sandra M Vandomelen, SAC-IT
• Village of Hales Corners
• Village of Hales Corners (Hales Corners Fire Dept)
• Walgreen Co (Walgreens #07568)
• Mark Wanezek
• David Mark Weis, D.D.S.

• Physical Therapist in Hales Corners, WI
• Providers in Hales Corners, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.