Provider Demographics
NPI:1578835807
Name:GASPAR, VANESSA (PTA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GASPAR
Suffix:
Gender:F
Credentials:PTA
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 396
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33443-0396
Mailing Address - Country:US
Mailing Address - Phone:954-632-5102
Mailing Address - Fax:954-632-5102
Practice Address - Street 1:212 EAST HILLSBORO BLVD #396
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33443-0396
Practice Address - Country:US
Practice Address - Phone:954-632-5102
Practice Address - Fax:954-632-5102
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23139225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant