Provider Demographics
NPI:1235673674
Name:VOLMAR-VIROBYAN, VANESSA (DPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VOLMAR-VIROBYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:VOLMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:415 LEONARD ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3944
Mailing Address - Country:US
Mailing Address - Phone:631-388-2460
Mailing Address - Fax:
Practice Address - Street 1:8030 SOQUEL AVE STE 200
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2096
Practice Address - Country:US
Practice Address - Phone:831-464-8200
Practice Address - Fax:831-295-6735
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100146108Medicare PIN
NYQ4WFH1Medicare PIN