Provider Demographics
NPI:1649614678
Name:JOHNSON, VANESSA WHITE (MPT)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:WHITE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29619 ORCHARD GROVE DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-3964
Mailing Address - Country:US
Mailing Address - Phone:281-413-6088
Mailing Address - Fax:
Practice Address - Street 1:29619 ORCHARD GROVE DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-3964
Practice Address - Country:US
Practice Address - Phone:281-413-6088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist