Provider Demographics
NPI:1336852714
Name:CANTORAN, VANESSA (PTA)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:CANTORAN
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 1:900 HENDERSON AVE APT 1013
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3807
Mailing Address - Country:US
Mailing Address - Phone:713-377-3265
Mailing Address - Fax:
Practice Address - Street 1:409 GREENE ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-6701
Practice Address - Country:US
Practice Address - Phone:281-332-4738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2171236225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant