Provider Demographics
NPI:1639308364
Name:DASALLA, VANESSA S
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:S
Last Name:DASALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:S
Other - Last Name:VALIENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95-720 LANIKUHANA AVE
Mailing Address - Street 2:140
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2985
Mailing Address - Country:US
Mailing Address - Phone:808-623-6244
Mailing Address - Fax:808-623-6414
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:140
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-623-6244
Practice Address - Fax:808-623-6414
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist