Provider Demographics
NPI:1760993505
Name:VIVA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:VIVA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANNAN
Authorized Official - Middle Name:MH
Authorized Official - Last Name:SIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, CLT
Authorized Official - Phone:248-318-9722
Mailing Address - Street 1:7605 1/2 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305
Mailing Address - Country:US
Mailing Address - Phone:248-318-9722
Mailing Address - Fax:
Practice Address - Street 1:7605 1/2 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305
Practice Address - Country:US
Practice Address - Phone:248-318-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty