Provider Demographics
NPI:1104477637
Name:VANEGDOM, ANNA (PTA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VANEGDOM
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 1:12590 WHITECAP LN
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8778
Mailing Address - Country:US
Mailing Address - Phone:360-540-4937
Mailing Address - Fax:
Practice Address - Street 1:12590 WHITECAP LN
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8778
Practice Address - Country:US
Practice Address - Phone:360-540-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant