Provider Demographics
NPI:1881835668
Name:GANN, VANESSA KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:KAY
Last Name:GANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:KAY
Other - Last Name:VESELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 3666
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3666
Mailing Address - Country:US
Mailing Address - Phone:361-572-4246
Mailing Address - Fax:361-572-9490
Practice Address - Street 1:5205 JOHN STOCKBAUER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1866
Practice Address - Country:US
Practice Address - Phone:361-572-4246
Practice Address - Fax:361-572-9490
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1187183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist