Provider Demographics
NPI:1134427339
Name:TOOTLE, VANESSA (PT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:TOOTLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 PAULSEN ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3662
Mailing Address - Country:US
Mailing Address - Phone:912-525-1280
Mailing Address - Fax:912-354-5970
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:BUILDING A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3662
Practice Address - Country:US
Practice Address - Phone:912-525-1280
Practice Address - Fax:912-354-5970
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist