Provider Demographics
NPI:1356047740
Name:VADHEL, VAGISHA (PT,MPT)
Entity type:Individual
Prefix:MRS
First Name:VAGISHA
Middle Name:
Last Name:VADHEL
Suffix:
Gender:F
Credentials:PT,MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 TIGER LILLY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-3770
Mailing Address - Country:US
Mailing Address - Phone:813-613-2204
Mailing Address - Fax:
Practice Address - Street 1:6107 MEMORIAL HWY STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4564
Practice Address - Country:US
Practice Address - Phone:813-890-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT29592OtherPHYSICAL THERAPY STATE LICENSE