MEDICARE: VANESSA CAROLINA SIMPSON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1278974	TX

General Provider Information

NPI Number	:	1417729807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA CAROLINA SIMPSON PT, DPT

Provider Business Mailing Address
First Line	:	5628 MACRAE ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76148-3918
Country	:	US
Telephone Number	:	817-899-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2432 AVONDALE HASLET RD STE 300
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3428
Country	:	US
Telephone Number	:	817-717-9111
Fax Number	:	817-717-8999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	06/03/2025

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