Provider Demographics
NPI:1659786960
Name:NANDIN, VANESSA (DPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:NANDIN
Suffix:
Gender:F
Credentials:DPT
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 15031
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21282-5031
Mailing Address - Country:US
Mailing Address - Phone:410-566-2501
Mailing Address - Fax:410-566-3025
Practice Address - Street 1:20 CROSSROADS DR
Practice Address - Street 2:SUITE 13
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5419
Practice Address - Country:US
Practice Address - Phone:410-363-0015
Practice Address - Fax:410-356-7763
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist