Provider Demographics
NPI:1457786907
Name:DAMIANI, VANESSA (PT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DAMIANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:MOGROVEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2954 RIKKARD DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4615
Mailing Address - Country:US
Mailing Address - Phone:805-449-3480
Mailing Address - Fax:
Practice Address - Street 1:145 HODENCAMP RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5810
Practice Address - Country:US
Practice Address - Phone:661-309-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist