Provider Demographics
NPI:1790964799
Name:VILO, JOSE LYNDO JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LYNDO
Last Name:VILO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16700 GLEN LAKES DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5313
Mailing Address - Country:US
Mailing Address - Phone:502-370-7331
Mailing Address - Fax:502-384-4087
Practice Address - Street 1:16700 GLEN LAKES DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5313
Practice Address - Country:US
Practice Address - Phone:502-370-7331
Practice Address - Fax:502-384-4087
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005036225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist