Provider Demographics
NPI:1659601615
Name:VIANA, FLAVIA COMELLI (PT)
Entity Type:Individual
Prefix:
First Name:FLAVIA
Middle Name:COMELLI
Last Name:VIANA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4009
Mailing Address - Country:US
Mailing Address - Phone:562-862-7950
Mailing Address - Fax:562-862-9973
Practice Address - Street 1:9990 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4009
Practice Address - Country:US
Practice Address - Phone:562-862-7950
Practice Address - Fax:562-862-9973
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist