Healthcare Provider Details

I. General information

NPI: 1457646929
Provider Name (Legal Business Name): VANESSA CHIH YUEH CORNWELL-CHIU D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NUT TREE RD STE 260
VACAVILLE CA
95687-4100
US

IV. Provider business mailing address

1020 NUT TREE RD STE 260
VACAVILLE CA
95687-4100
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-8290
  • Fax: 707-624-7362
Mailing address:
  • Phone: 707-624-8290
  • Fax: 707-624-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: