Provider Demographics
NPI:1053317529
Name:VIGOR AND VITALITY, LLC
Entity Type:Organization
Organization Name:VIGOR AND VITALITY, LLC
Other - Org Name:AZULCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIKHANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-353-5600
Mailing Address - Street 1:1330 WONDER WORLD DR
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7567
Mailing Address - Country:US
Mailing Address - Phone:512-353-5600
Mailing Address - Fax:512-353-5602
Practice Address - Street 1:1330 WONDER WORLD DR
Practice Address - Street 2:STE 104
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7567
Practice Address - Country:US
Practice Address - Phone:512-353-5600
Practice Address - Fax:512-353-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-4836Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER