Provider Demographics
NPI:1376000836
Name:VIZMANOS, JOEL RIOS
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:RIOS
Last Name:VIZMANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27238 CHURCH CREEK LOOP NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7448
Mailing Address - Country:US
Mailing Address - Phone:425-346-3830
Mailing Address - Fax:
Practice Address - Street 1:27238 CHURCH CREEK LOOP NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-7448
Practice Address - Country:US
Practice Address - Phone:425-346-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist