Provider Demographics
NPI:1497142764
Name:SILVA, VICTOR JONATHAN III (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:JONATHAN
Last Name:SILVA
Suffix:III
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 27TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-7831
Mailing Address - Country:US
Mailing Address - Phone:941-747-3031
Mailing Address - Fax:941-747-9549
Practice Address - Street 1:1701 27TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-747-3031
Practice Address - Fax:941-747-9549
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer