Healthcare Provider Details

I. General information

NPI: 1194326371
Provider Name (Legal Business Name): VANESSA ANGEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13564 VILLAGE PARK DR UNIT 125
ORLANDO FL
32837-7761
US

IV. Provider business mailing address

13564 VILLAGE PARK DR UNIT 125
ORLANDO FL
32837-7761
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-0287
  • Fax: 321-841-9823
Mailing address:
  • Phone: 321-843-0287
  • Fax: 321-841-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT36481
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: