Provider Demographics
NPI:1316388432
Name:OBILLO, VICTOR EMMANUEL III
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:EMMANUEL
Last Name:OBILLO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VICTOR EMMANUEL
Other - Middle Name:GALLETES
Other - Last Name:OBILLO
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4857 OSPREY LN
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5465
Mailing Address - Country:US
Mailing Address - Phone:425-939-0799
Mailing Address - Fax:
Practice Address - Street 1:2235 LAKE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6030
Practice Address - Country:US
Practice Address - Phone:425-338-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60251293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist