Provider Demographics
NPI:1619087137
Name:VACHAL, JOHN F (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:VACHAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 N CLARIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-4535
Mailing Address - Country:US
Mailing Address - Phone:907-745-5082
Mailing Address - Fax:
Practice Address - Street 1:3750 E. COUNTRY FIELD CIRCLE, #A
Practice Address - Street 2:MERIDIAN MEDICAL PARK
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-376-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1647OtherLICENSE #