Provider Demographics
NPI:1053950873
Name:REGO, VANESSA DEMELO (PTA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DEMELO
Last Name:REGO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SLADE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-1350
Mailing Address - Country:US
Mailing Address - Phone:774-526-5053
Mailing Address - Fax:
Practice Address - Street 1:4263 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1714
Practice Address - Country:US
Practice Address - Phone:774-955-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant