Provider Demographics
NPI:1790799906
Name:VIA, MICHAEL C (MSPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:VIA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 OLD ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3491
Mailing Address - Country:US
Mailing Address - Phone:941-929-9220
Mailing Address - Fax:239-593-1195
Practice Address - Street 1:9051 TAMIAMI TRL N
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2596
Practice Address - Country:US
Practice Address - Phone:239-591-4711
Practice Address - Fax:239-593-1195
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9112Medicare UPIN