Provider Demographics
NPI:1003806597
Name:VIAL, ERIC ANTHONY (MS,PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANTHONY
Last Name:VIAL
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3711
Mailing Address - Country:US
Mailing Address - Phone:530-257-7711
Mailing Address - Fax:530-257-2170
Practice Address - Street 1:1525 E WINDMILL LN STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1903
Practice Address - Country:US
Practice Address - Phone:702-202-1280
Practice Address - Fax:702-361-8596
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171080100OtherOWCP PROVIDER NUMBER
CA171080100OtherOWCP PROVIDER NUMBER