Provider Demographics
NPI:1023257896
Name:VITAL, MARIA C
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:VITAL
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 1:9995 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4662
Mailing Address - Country:US
Mailing Address - Phone:786-263-0063
Mailing Address - Fax:305-279-3611
Practice Address - Street 1:9995 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4662
Practice Address - Country:US
Practice Address - Phone:786-263-0063
Practice Address - Fax:305-279-3611
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47017172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist