Provider Demographics
NPI:1821365297
Name:VIGIL, RAYMOND B (PT, OCS)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:B
Last Name:VIGIL
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-0470
Mailing Address - Country:US
Mailing Address - Phone:303-961-0122
Mailing Address - Fax:
Practice Address - Street 1:70 S 20TH AVE
Practice Address - Street 2:UNIT I
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3703
Practice Address - Country:US
Practice Address - Phone:303-961-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic