Provider Demographics
NPI:1609400936
Name:VDCPT801 LLC
Entity Type:Organization
Organization Name:VDCPT801 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGILIO ENRICO
Authorized Official - Middle Name:PELAEZ
Authorized Official - Last Name:DEL CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-671-5384
Mailing Address - Street 1:1003 W FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-2007
Mailing Address - Country:US
Mailing Address - Phone:801-671-5384
Mailing Address - Fax:
Practice Address - Street 1:1003 W FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-2007
Practice Address - Country:US
Practice Address - Phone:801-671-5384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty