Basic Information
| Provider Information | |||||||||
| NPI: | 1316972243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDYKE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHYSICAL THERAPIST A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300A PRINCETON HIGHTSTOWN RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | EAST WINDSOR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085201411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094264442 | ||||||||
| FaxNumber: | 6094430910 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PRINCETON HIGHTSTOWN ROAD | ||||||||
| Address2: | BUILDING A STE 201 | ||||||||
| City: | EAST WINDSOR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085201411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094264442 | ||||||||
| FaxNumber: | 6094430910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 40QB00201100 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.