Basic Information
| Provider Information | |||||||||
| NPI: | 1023775103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDERLINDEN | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | BLAKE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 SPRING RD APT 38 | ||||||||
| Address2: | |||||||||
| City: | MOORPARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930211248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053045098 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44303 LOWTREE AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619405494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2021 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 301385 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.