Provider Demographics
NPI:1255717427
Name:ISTOC, VANESSA CHIU (DPT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:CHIU
Last Name:ISTOC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:CHIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20224 SHERMAN WAY
Mailing Address - Street 2:UNIT 68
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3237
Mailing Address - Country:US
Mailing Address - Phone:818-636-7549
Mailing Address - Fax:818-348-6854
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:STE 206
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-340-8320
Practice Address - Fax:818-348-6854
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist