Provider Demographics
NPI:1750621496
Name:WEST, VANESSA A (ATC, LAT, MA)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:A
Last Name:WEST
Suffix:
Gender:F
Credentials:ATC, LAT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIDGEVIEW DR
Mailing Address - Street 2:APT H6
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5049
Mailing Address - Country:US
Mailing Address - Phone:225-715-1813
Mailing Address - Fax:
Practice Address - Street 1:18333 HIGHWAY 182
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:LA
Practice Address - Zip Code:70514-1449
Practice Address - Country:US
Practice Address - Phone:337-924-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2000632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer