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General NPI Number Information
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NPI Number | 1659041192
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Entity Type | Individual
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Provider Name | VANESSA CAMERON VALLE
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Gender | Female
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 4935 N 30TH ST STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3109
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Country | US
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Telephone | 719-266-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 5823 WALSH PT APT 306
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-1786
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Country | US
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Telephone | 650-477-9552
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PTL.0019801
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License Number State | CO
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