| Doctor Name: | JASON R VANDEVENTER |
| NPI Number: | 1205831070 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT |
| License Number: | 05007082A |
| Business Practice Address: | 719 S Rogers St Bloomington, IN - 474032335 |
| Business Phone Number: | 8123234475 |
| Business Fax Number: | 8123234478 |
| Mailing Address: | 550 S Landmark Ave, BLOOMINGTON |
| State: | IN |
| Postal Code: | 474033239 |
| Phone Number: | 8123234475 |
| Fax Number: | 8123234478 |
| NPI Enumeration Date: | 06/16/2005 |
| NPI Last Update Date: | 09/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 05007082A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |