Provider Demographics
NPI:1316078025
Name:VESNAVER, MARYANN T (PT)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:T
Last Name:VESNAVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 CIELO GRANDE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-1554
Mailing Address - Country:US
Mailing Address - Phone:805-461-3269
Mailing Address - Fax:805-461-3269
Practice Address - Street 1:1191 CRESTON RD STE 115
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3033
Practice Address - Country:US
Practice Address - Phone:805-239-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9222208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation