Provider Demographics
NPI:1356325658
Name:VANIMAN, KAREN (MPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:VANIMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39969 WILLIAMSBURG PL
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5578
Mailing Address - Country:US
Mailing Address - Phone:951-719-3234
Mailing Address - Fax:
Practice Address - Street 1:39969 WILLIAMSBURG PL
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5578
Practice Address - Country:US
Practice Address - Phone:951-719-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT229740OtherBLUE SHIELD
CAWPT22974AMedicare UPIN
CAWPT22974AMedicare ID - Type Unspecified