Provider Demographics
NPI:1942469234
Name:VIZCARRONDO COLON, JOHANNY
Entity Type:Individual
Prefix:
First Name:JOHANNY
Middle Name:
Last Name:VIZCARRONDO COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24011 MADACA LANE # 108
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954
Mailing Address - Country:US
Mailing Address - Phone:787-550-7835
Mailing Address - Fax:
Practice Address - Street 1:24011 MADACA LANE # 108
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954
Practice Address - Country:US
Practice Address - Phone:787-550-7835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist