Healthcare Provider Details

I. General information

NPI: 1073120473
Provider Name (Legal Business Name): VMPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 10/26/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 KERBEY LN
AUSTIN TX
78731-6217
US

IV. Provider business mailing address

1404 LARKWOOD DR
AUSTIN TX
78723-2539
US

V. Phone/Fax

Practice location:
  • Phone: 917-664-3453
  • Fax:
Mailing address:
  • Phone: 917-664-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VANESSA MUNCRIEF
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 917-664-3453