Provider Demographics
NPI:1164477402
Name:PATENAUDE, VANESSA (PT)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:PATENAUDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04757-4545
Mailing Address - Country:US
Mailing Address - Phone:207-764-7041
Mailing Address - Fax:207-764-8591
Practice Address - Street 1:38 PLEASANT HILL DR
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:ME
Practice Address - Zip Code:04757-4545
Practice Address - Country:US
Practice Address - Phone:207-764-7041
Practice Address - Fax:207-764-8591
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist