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Contact Information

JEREMY S VANDEHURST, L-AT
2170 SOUTH AVE # B
SOUTH LAKE TAHOE, CA96150-7008
 Phone: 530-208-8253
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

207PS0010X 93 Physician/Emergency Medicine
 

Health Educator

174H00000X
 

Kinesiotherapist

226300000X
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
 

Prevention Professional

405300000X
 

Sports Medicine

207XX0005X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for JEREMY S VANDEHURST · (Male)

NPI # 1861027625
Status Active
Credentials L-AT
Entity Individual
Enumeration date 03/11/2020
Last updated 03/11/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • NV License # 0506428
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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