Provider Demographics
NPI:1033243084
Name:VINLUAN, JOANN SANTOS (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:SANTOS
Last Name:VINLUAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6447
Mailing Address - Country:US
Mailing Address - Phone:212-420-7280
Mailing Address - Fax:
Practice Address - Street 1:371 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6447
Practice Address - Country:US
Practice Address - Phone:212-420-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0220422Medicaid
NY0220422Medicaid