Healthcare Provider Details

I. General information

NPI: 1932687639
Provider Name (Legal Business Name): VANESSA DE LA VEGA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NEW LEICESTER HWY
ASHEVILLE NC
28806-1917
US

IV. Provider business mailing address

9724 COMMERCE CENTER CT STE B
FORT MYERS FL
33908-3608
US

V. Phone/Fax

Practice location:
  • Phone: 828-225-3838
  • Fax: 828-225-3839
Mailing address:
  • Phone: 239-223-0484
  • Fax: 239-790-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17908
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number37437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: