Provider Demographics
NPI:1932295284
Name:MCNAIR, VANESSA J (DPT)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:J
Last Name:MCNAIR
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 1:317 NORTH RUST AVENUE
Mailing Address - Street 2:
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-9552
Mailing Address - Country:US
Mailing Address - Phone:479-233-0104
Mailing Address - Fax:479-736-3138
Practice Address - Street 1:317 N RUST AVE
Practice Address - Street 2:
Practice Address - City:GENTRY
Practice Address - State:AR
Practice Address - Zip Code:72734-9552
Practice Address - Country:US
Practice Address - Phone:479-233-0104
Practice Address - Fax:479-736-3138
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2913225100000X
OK3964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161942721Medicaid
AR161942721Medicaid