Provider Demographics
NPI:1003502162
Name:VANCAMP, ANNA (PTA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VANCAMP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4906
Mailing Address - Country:US
Mailing Address - Phone:719-345-4097
Mailing Address - Fax:719-249-1516
Practice Address - Street 1:722 S 8TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4906
Practice Address - Country:US
Practice Address - Phone:719-345-4097
Practice Address - Fax:719-249-1516
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015239225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant