Provider Demographics
NPI:1104203629
Name:VILES, ROBERT RAY II (MS, ATC, CES)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RAY
Last Name:VILES
Suffix:II
Gender:M
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1315
Mailing Address - Country:US
Mailing Address - Phone:540-831-5164
Mailing Address - Fax:540-831-6114
Practice Address - Street 1:101 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141
Practice Address - Country:US
Practice Address - Phone:540-831-5164
Practice Address - Fax:540-831-6114
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260019692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer