Provider Demographics
NPI:1225250582
Name:VITTO, JOHN IAN LLAVE (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN IAN
Middle Name:LLAVE
Last Name:VITTO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 VILLAGE ML
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1062
Mailing Address - Country:US
Mailing Address - Phone:845-270-7095
Mailing Address - Fax:
Practice Address - Street 1:27 VILLAGE MILL
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1062
Practice Address - Country:US
Practice Address - Phone:845-270-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist