Provider Demographics
NPI:1487384368
Name:VANDER MOLEN, TESSA (DPT)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:
Last Name:VANDER MOLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4046
Mailing Address - Country:US
Mailing Address - Phone:318-443-5278
Mailing Address - Fax:318-443-1906
Practice Address - Street 1:1305 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-4046
Practice Address - Country:US
Practice Address - Phone:318-443-5278
Practice Address - Fax:318-443-1906
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
72-1251510OtherAGIILUS HEALTH, INC.