Provider Demographics
NPI:1871505446
Name:VASOLO, GLORIA (PT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:VASOLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:INES
Other - Last Name:VASSOLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:17100 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3675
Mailing Address - Country:US
Mailing Address - Phone:305-555-1212
Mailing Address - Fax:
Practice Address - Street 1:17100 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3675
Practice Address - Country:US
Practice Address - Phone:305-555-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD868YOtherLEGACY
FLAD868YOtherLEGACY