Provider Demographics
NPI:1790810315
Name:VITO, CLAIRE L (PT)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:L
Last Name:VITO
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 1:8424 JEAN PARRISH CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2825
Mailing Address - Country:US
Mailing Address - Phone:505-821-2316
Mailing Address - Fax:
Practice Address - Street 1:7500 BARSTOW ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4951
Practice Address - Country:US
Practice Address - Phone:505-821-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist