=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952811556
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA GENTLEMAN CANGIALOSI LM, CPM, LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2017
-----------------------------------------------------
Last Update Date | 03/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 STONE THROW DR
-----------------------------------------------------
City | MURRELLS INLET
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29576-8213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-283-7806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 STONE THROW DR
-----------------------------------------------------
City | MURRELLS INLET
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29576-8213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-283-7806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 2998
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | LMW-0076
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------