Provider Demographics
NPI:1497763320
Name:VITOLO, RICHARD (LPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:VITOLO
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 VILLAWAY E
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33876-7944
Mailing Address - Country:US
Mailing Address - Phone:863-202-0485
Mailing Address - Fax:
Practice Address - Street 1:2002 VILLAWAY E
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33876-7944
Practice Address - Country:US
Practice Address - Phone:863-202-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist