Provider Demographics
NPI:1578896874
Name:VIACLOVSKY, DAVID WAYNE (LAT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:VIACLOVSKY
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 TOWN CENTER BLVD APT 812
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6233
Mailing Address - Country:US
Mailing Address - Phone:281-543-7880
Mailing Address - Fax:713-500-0690
Practice Address - Street 1:7404 TOWN CENTER BLVD APT 812
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6233
Practice Address - Country:US
Practice Address - Phone:281-543-7880
Practice Address - Fax:713-500-0690
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT15342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer