Provider Demographics
NPI:1679666481
Name:VANECK, MAJA CORNE (PT,DPT,COMT,OCS)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:CORNE
Last Name:VANECK
Suffix:
Gender:F
Credentials:PT,DPT,COMT,OCS
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 3515
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-3515
Mailing Address - Country:US
Mailing Address - Phone:901-757-1200
Mailing Address - Fax:901-756-7010
Practice Address - Street 1:8066 WALNUT RUN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8841
Practice Address - Country:US
Practice Address - Phone:901-757-1200
Practice Address - Fax:901-756-7010
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT5383225100000X
ARPT2079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4123418OtherBCBS PROVIDER NUMBER
TN4123418OtherBCBS PROVIDER NUMBER