Provider Demographics
NPI:1730919671
Name:VANDENBERGH, BRETT S (DPT)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:S
Last Name:VANDENBERGH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 W 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5470
Mailing Address - Country:US
Mailing Address - Phone:952-925-4085
Mailing Address - Fax:
Practice Address - Street 1:1500 MADISON AVE STE 5A
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-6693
Practice Address - Country:US
Practice Address - Phone:715-941-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist