Provider Demographics
NPI:1942008446
Name:VANDERMAAS, LAURIE A (PTA)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:VANDERMAAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-0061
Mailing Address - Country:US
Mailing Address - Phone:352-571-5554
Mailing Address - Fax:
Practice Address - Street 1:12120 COUNTY ROAD 103
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-2987
Practice Address - Country:US
Practice Address - Phone:352-571-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PTA15612225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant