Provider Demographics
NPI:1063004190
Name:WAY, VANESSA (DPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MEADOWOOD DR APT A2
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-9214
Mailing Address - Country:US
Mailing Address - Phone:970-618-2216
Mailing Address - Fax:
Practice Address - Street 1:1200 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1564
Practice Address - Country:US
Practice Address - Phone:970-618-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist