Healthcare Provider Details

I. General information

NPI: 1104065028
Provider Name (Legal Business Name): VANESA GARCES MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 ASHLAND AVE
CHARLOTTE NC
28205-3604
US

IV. Provider business mailing address

2016 ASHLAND AVE
CHARLOTTE NC
28205-3604
US

V. Phone/Fax

Practice location:
  • Phone: 704-342-2027
  • Fax:
Mailing address:
  • Phone: 704-342-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5031
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: