Provider Demographics
NPI:1164820049
Name:VIAL PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:VIAL PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VIAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-257-7711
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 1:515 ASH ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3711
Practice Address - Country:US
Practice Address - Phone:530-257-7711
Practice Address - Fax:530-257-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty