Provider Demographics
NPI:1790558310
Name:PHYSIO VITAE LLC
Entity Type:Organization
Organization Name:PHYSIO VITAE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DI FAUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-902-8130
Mailing Address - Street 1:7441 WAYNE AVE APT 4Q
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2571
Mailing Address - Country:US
Mailing Address - Phone:305-902-8130
Mailing Address - Fax:
Practice Address - Street 1:7441 WAYNE AVE APT 4Q
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2571
Practice Address - Country:US
Practice Address - Phone:305-902-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty