Provider Demographics
NPI:1932687639
Name:DE LA VEGA, VANESSA (PT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DE LA VEGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9724 COMMERCE CENTER CT
Mailing Address - Street 2:STE B
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3608
Mailing Address - Country:US
Mailing Address - Phone:239-223-0484
Mailing Address - Fax:239-790-0969
Practice Address - Street 1:149 NEW LEICESTER HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1917
Practice Address - Country:US
Practice Address - Phone:828-225-3838
Practice Address - Fax:828-225-3839
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374372251X0800X
NC17908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist