Provider Demographics
NPI:1003187949
Name:VANTA, VESMINA L (RPT)
Entity Type:Individual
Prefix:MS
First Name:VESMINA
Middle Name:L
Last Name:VANTA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 BLUEBONNET WAY
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7442
Mailing Address - Country:US
Mailing Address - Phone:904-400-2894
Mailing Address - Fax:
Practice Address - Street 1:803 OAK ST
Practice Address - Street 2:GOVERNORS CREEK HEALTH AND REHAB
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-4317
Practice Address - Country:US
Practice Address - Phone:904-284-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT88592251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics