Basic Information
| Provider Information | |||||||||
| NPI: | 1750567715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VESPA MCGRANN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | VESPA | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | MARISA | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10707 ANGLESEY CT | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282788448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047073763 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 439 CHANNEL RD | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297106102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037467800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2008 | ||||||||
| LastUpdateDate: | 03/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11379 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 5813 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.