Provider Demographics
NPI:1184688525
Name:VILE, MICHAEL CHRISTOPHER (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:VILE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MANCHESTER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1366
Mailing Address - Country:US
Mailing Address - Phone:609-693-9345
Mailing Address - Fax:609-693-9347
Practice Address - Street 1:34 MANCHESTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1366
Practice Address - Country:US
Practice Address - Phone:609-693-9345
Practice Address - Fax:609-693-9347
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01000500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist