Healthcare Provider Details

I. General information

NPI: 1821589755
Provider Name (Legal Business Name): DR. KATHLEEN VIGO, PT, DPT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2018
Last Update Date: 05/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 NW 96TH DR
CORAL SPRINGS FL
33076-2606
US

IV. Provider business mailing address

5011 NW 96TH DR
CORAL SPRINGS FL
33076-2606
US

V. Phone/Fax

Practice location:
  • Phone: 954-295-5067
  • Fax:
Mailing address:
  • Phone: 954-295-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24116
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT24116
License Number StateFL

VIII. Authorized Official

Name: DR. KATHLEEN MARIE VIGO
Title or Position: OWNER
Credential: PT, DPT
Phone: 954-295-5067