Healthcare Provider Details

I. General information

NPI: 1255157400
Provider Name (Legal Business Name): VANESSA LEE MCCARTNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 STATE ROAD 436
WINTER PARK FL
32792-2255
US

IV. Provider business mailing address

896 BENCHWOOD DR
WINTER SPRINGS FL
32708-5112
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-5029
  • Fax:
Mailing address:
  • Phone: 407-924-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: