Provider Demographics
NPI:1700181419
Name:WARRIOR, VANESSA (PT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:WARRIOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24191 GRAYSTON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3839
Mailing Address - Country:US
Mailing Address - Phone:949-636-5816
Mailing Address - Fax:
Practice Address - Street 1:980 ROOSEVELT
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3672
Practice Address - Country:US
Practice Address - Phone:949-636-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics