Provider Demographics
NPI:1992815013
Name:VASQUEZ, CHARISSE KRISTINE P (RPT)
Entity type:Individual
Prefix:MS
First Name:CHARISSE
Middle Name:KRISTINE P
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:14610 DELANO ST APT 110
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2861
Mailing Address - Country:US
Mailing Address - Phone:818-448-1178
Mailing Address - Fax:
Practice Address - Street 1:14148 MAGNOLIA BLVD
Practice Address - Street 2:STE 105 AQUATIC PHYSICAL THERAPY AND REHAB
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423
Practice Address - Country:US
Practice Address - Phone:818-784-3838
Practice Address - Fax:818-784-3803
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist