Provider Demographics
NPI:1467148205
Name:KACZMAREK, VANESSA RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAE
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 CAHABA RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6825
Mailing Address - Country:US
Mailing Address - Phone:941-539-4395
Mailing Address - Fax:
Practice Address - Street 1:4500 CAHABA RIVER BLVD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-6825
Practice Address - Country:US
Practice Address - Phone:941-539-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH70822251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology