Provider Demographics
NPI:1649004037
Name:FITZPATRICK, VANESSA RAE (LMT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:RAE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 MARY DR
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9381
Mailing Address - Country:US
Mailing Address - Phone:269-225-7610
Mailing Address - Fax:
Practice Address - Street 1:1286 MARY DR
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9381
Practice Address - Country:US
Practice Address - Phone:269-225-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist