Provider Demographics
NPI:1568699262
Name:OLIVA, VANESSA VALERIE GARZON (PT)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA VALERIE
Middle Name:GARZON
Last Name:OLIVA
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 1:5313 COSTA MESA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3932
Mailing Address - Country:US
Mailing Address - Phone:719-566-1807
Mailing Address - Fax:
Practice Address - Street 1:100 SAN CARLOS RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2651
Practice Address - Country:US
Practice Address - Phone:719-566-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist