Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. JEREMY SCOTT VANDEHURST, L-AT
Active Sole ProprietorSports Medicine (EM) · SOUTH LAKE TAHOE, CA
Registration Details
- NPI Number
- 1861027625
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 11, 2020 (6.115486117475 yrs)
- Last Updated
- Mar 11, 2020
- Licenses
-
0506428 (NV)0506428 (NV)0506428 (NV)0506428 (NV)0506428 (NV)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2170 SOUTH AVE # BSOUTH LAKE TAHOE, CA, 961507008Browse CA providers · Browse ZIP 96150
- Phone
- 5302088253
- Primary Specialty
-
Sports Medicine (EM)
207PS0010X
- Additional Specialty
- Adult Reconstructive Orthopaedic Surgery
- Additional Specialty
- Physical Medicine & Rehabilitation
- Additional Specialty
- Occupational Therapist
- Additional Specialty
- 405300000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.