Provider Demographics
NPI:1184754673
Name:CARLSON, VANESSA HOPE (PTA)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:HOPE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1009
Mailing Address - Country:US
Mailing Address - Phone:763-682-4167
Mailing Address - Fax:
Practice Address - Street 1:101 14TH ST NE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2927
Practice Address - Country:US
Practice Address - Phone:763-684-3880
Practice Address - Fax:763-684-3881
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant