Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT8859 | FL |
NPI | 1003187949 |
---|---|
Provider Name | Ms. Vesmina L Vanta |
First Address | Fleming Island, FL 32003-7442 |
Second Address | Green Cove Springs, FL 32043-4317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 24/01/2012 |