Provider Demographics
NPI:1801271523
Name:VIGIL, MARK JOSEPH (PT DPT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:VIGIL
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Gender:M
Credentials:PT DPT
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Mailing Address - Street 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE E8
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-883-7518
Mailing Address - Fax:505-883-8653
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE E8
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-883-7518
Practice Address - Fax:505-883-8653
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-30
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Provider Licenses
StateLicense IDTaxonomies
NM4668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist