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General NPI Number Information
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NPI Number | 1376734632
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Entity Type | Individual
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Provider Name | VANESSA MARIE VANDER MPT
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Gender | Female
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 350 5TH AVE SUITE 5115
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City | NEW YORK
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State | NY
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Zip | 10118-0110
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Country | US
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Telephone | 866-601-6474
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Fax |
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Provider Business Mailing Address
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Address Line | 350 5TH AVE SUITE 5115
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City | NEW YORK
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State | NY
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Zip | 10118-0110
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Country | US
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Telephone | 866-601-6474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0295201
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License Number State | NY
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