Provider Demographics
NPI:1205484763
Name:VEGA, ANNA W (PT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:W
Last Name:VEGA
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARGARET
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 ALBEMARLE SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7405
Mailing Address - Country:US
Mailing Address - Phone:434-817-7847
Mailing Address - Fax:434-465-6834
Practice Address - Street 1:504 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-7405
Practice Address - Country:US
Practice Address - Phone:434-817-7847
Practice Address - Fax:434-465-6834
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist