Provider Demographics
NPI:1417689399
Name:VIVO PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:VIVO PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-235-6489
Mailing Address - Street 1:170 17TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-7201
Mailing Address - Country:US
Mailing Address - Phone:831-235-6489
Mailing Address - Fax:
Practice Address - Street 1:170 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-7201
Practice Address - Country:US
Practice Address - Phone:831-235-6489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy