Healthcare Provider Details

I. General information

NPI: 1043200660
Provider Name (Legal Business Name): VANNASSA ZONTENNIA CASTON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1602
US

IV. Provider business mailing address

201 JOSHUA CIR
SMITHFIELD VA
23430-1653
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7666
  • Fax:
Mailing address:
  • Phone: 757-357-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306001611
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: