Healthcare Provider Details

I. General information

NPI: 1245120005
Provider Name (Legal Business Name): VANESSA ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E 40TH ST FL 12
NEW YORK NY
10016-0402
US

IV. Provider business mailing address

209 W 80TH ST APT 3C
NEW YORK NY
10024-7067
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-7427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: