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NPI Code Detail

MEDICARE: VANESSA VASQUEZ

MEDICARE: VANESSA VASQUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical TherapistPT23431FL
2222Q00000XDevelopmental Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT23431OTHERFLFLORIDA LICENSE

General Provider Information

NPI Number : 1639150329
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA VASQUEZ
Provider Business Mailing Address
First Line : 10507 WILLOWBRAE DR
Second Line :
City : TAMPA
State : FL
Zip : 33624-5223
Country : US
Telephone Number : 630-698-3528
Fax Number :
Provider Business Practice Location Address
First Line : 13101 BRUCE B DOWNS BLVD
Second Line : USF EARLY STEPS
City : TAMPA
State : FL
Zip : 33612-3803
Country : US
Telephone Number : 813-974-7938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 03/29/2017

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Directions to “ VANESSA VASQUEZ ” Practice Location

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