Provider Demographics
NPI:1538415591
Name:VONLEER, WILLIAM JOHN (ATC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:VONLEER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ERINDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2456
Mailing Address - Country:US
Mailing Address - Phone:856-745-3664
Mailing Address - Fax:
Practice Address - Street 1:235 HARTFORD RD
Practice Address - Street 2:LENAPE HIGH SCHOOL
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-4001
Practice Address - Country:US
Practice Address - Phone:609-654-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000347002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer