Provider Demographics
NPI:1083227078
Name:FLEMING BONILHA NEVES, VIVIAN (PT)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:FLEMING BONILHA NEVES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 SUNSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4231
Mailing Address - Country:US
Mailing Address - Phone:561-567-1139
Mailing Address - Fax:
Practice Address - Street 1:19801 HAMPTON DR STE C3
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2840
Practice Address - Country:US
Practice Address - Phone:561-576-3101
Practice Address - Fax:561-990-1344
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist