Provider Demographics
NPI:1316261175
Name:ACOSTA, VANESSA DEJILLO (PT,DPT)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:DEJILLO
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 PHILIPS HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5627
Mailing Address - Country:US
Mailing Address - Phone:618-303-1323
Mailing Address - Fax:
Practice Address - Street 1:3563 PHILIPS HWY STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5627
Practice Address - Country:US
Practice Address - Phone:618-303-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013824225100000X
NM3815225100000X
FLPT32443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist