Provider Demographics
NPI:1578281812
Name:VICES VISION REHAB AND WELLNESS LLC
Entity Type:Organization
Organization Name:VICES VISION REHAB AND WELLNESS LLC
Other - Org Name:J&J INTEGRATED PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:W
Authorized Official - Last Name:VICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-440-8962
Mailing Address - Street 1:8176 CRUMWELL DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7006
Mailing Address - Country:US
Mailing Address - Phone:217-504-3700
Mailing Address - Fax:317-536-3730
Practice Address - Street 1:455 GREENWOOD PARK SOUTH DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4505
Practice Address - Country:US
Practice Address - Phone:317-440-8962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty