MEDICARE: PATRICK E VIGIL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3894	NM

General Provider Information

NPI Number	:	1215238910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK E VIGIL DPT

Provider Business Mailing Address
First Line	:	1220 CAMINO DEL LLANO
Second Line	:
City	:	BELEN
State	:	NM
Zip	:	87002-2727
Country	:	US
Telephone Number	:	505-861-1200
Fax Number	:	505-861-1220

Provider Business Practice Location Address
First Line	:	535 HIGHWAY 314 SW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-9600
Country	:	US
Telephone Number	:	505-866-0055
Fax Number	:	505-866-0057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	11/16/2010

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Directions to “ PATRICK E VIGIL DPT” Practice Location

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