Mya Lee Vannurden, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12700 Issued in MN

Practice address

1903 S Congress Ave Ste 100
Boynton Beach, FL 33426-6553

Phone

(561) 432-0111

Fax

(561) 432-1075

NPI assigned

Jul 7, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1114650157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5840 CORPORATE WAY STE 101",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072040",
            "telephone_number": "561-432-0111",
            "fax_number": "561-432-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 S CONGRESS AVE STE 100",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334266553",
            "telephone_number": "561-432-0111",
            "fax_number": "561-432-1075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 10th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Deer River",
            "state": "MN",
            "postal_code": "566368795",
            "country_code": "US",
            "telephone_number": "218-246-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANNURDEN",
        "first_name": "MYA",
        "middle_name": "LEE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-07",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT42676",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mikhail Vassilenko, MD
• Kate A Vazquez, PA
• Jalileh Marie Vedaee, AGACNP-BC

• Physical Therapist in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.