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NPI Code Detail

MEDICARE: RICHARD JAMES VILT

MEDICARE: RICHARD JAMES VILT
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
1225700000XMassage Therapist33.017418OH

General Provider Information

NPI Number : 1356764963
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD JAMES VILT
Provider Business Mailing Address
First Line : 3727 BOSWORTH RD
Second Line : OUTREACH ACADEMY
City : CLEVELAND
State : OH
Zip : 44111-6037
Country : US
Telephone Number : 330-274-2272
Fax Number :
Provider Business Practice Location Address
First Line : 9772 DIAGONAL RD
Second Line : OUTREACH ACADEMY
City : MANTUA
State : OH
Zip : 44255-9128
Country : US
Telephone Number : 330-274-2272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2014
Last Update Date : 09/15/2015

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