Provider Demographics
NPI:1083225916
Name:VEGA, ANASTACIA (DPT, PT)
Entity Type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:602 W CHISHOLM DR
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-4348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 W CHISHOLM DR
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-4348
Practice Address - Country:US
Practice Address - Phone:828-388-8533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist