Provider Demographics
NPI:1649360793
Name:VITA, MICHAEL A JR (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:VITA
Suffix:JR
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4208 OAKTHORNE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5922
Mailing Address - Country:US
Mailing Address - Phone:919-624-2358
Mailing Address - Fax:919-787-1133
Practice Address - Street 1:4208 OAKTHORNE WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-5922
Practice Address - Country:US
Practice Address - Phone:919-624-2358
Practice Address - Fax:919-787-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist