Provider Demographics
NPI:1841656501
Name:VANDAN TAPARIA
Entity type:Organization
Organization Name:VANDAN TAPARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-549-2772
Mailing Address - Street 1:523 CAPE CORAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8545
Mailing Address - Country:US
Mailing Address - Phone:239-549-2772
Mailing Address - Fax:239-549-2332
Practice Address - Street 1:523 CAPE CORAL PKWY E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8545
Practice Address - Country:US
Practice Address - Phone:239-549-2772
Practice Address - Fax:239-549-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty