Healthcare Provider Details

I. General information

NPI: 1447088216
Provider Name (Legal Business Name): IMUA PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 JUNE BUG LN
VACAVILLE CA
95688-9311
US

IV. Provider business mailing address

7404 JUNE BUG LN
VACAVILLE CA
95688-9311
US

V. Phone/Fax

Practice location:
  • Phone: 510-449-8273
  • Fax:
Mailing address:
  • Phone: 510-449-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. VANESSA CHIH YUEH CORNWELL-CHIU
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT
Phone: 510-449-8273