Provider Demographics
NPI:1417975277
Name:ATKINSON, VANESSA Y (RPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:Y
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0863
Mailing Address - Country:US
Mailing Address - Phone:601-291-0423
Mailing Address - Fax:601-368-4571
Practice Address - Street 1:5250 GALAXIE DR
Practice Address - Street 2:SUITE K
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4311
Practice Address - Country:US
Practice Address - Phone:601-368-4570
Practice Address - Fax:601-368-4571
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT3426OtherPHYSICAL THERAPY LICENSE