Provider Demographics
NPI:1376225615
Name:VIGIL, KRISTAL (PT)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:VIGIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7849 TRAMWAY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2529
Mailing Address - Country:US
Mailing Address - Phone:505-821-3831
Mailing Address - Fax:505-212-0786
Practice Address - Street 1:5150 SAN FRANCISCO RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4396
Practice Address - Country:US
Practice Address - Phone:505-821-3831
Practice Address - Fax:505-212-0786
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT2114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist