Healthcare Provider Details

I. General information

NPI: 1790964799
Provider Name (Legal Business Name): JOSE LYNDO VILO JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16700 GLEN LAKES DRIVE
LOUISVILLE KY
40245-5313
US

IV. Provider business mailing address

16700 GLEN LAKES DRIVE
LOUISVILLE KY
40245-5313
US

V. Phone/Fax

Practice location:
  • Phone: 502-370-7331
  • Fax: 502-384-4087
Mailing address:
  • Phone: 502-370-7331
  • Fax: 502-384-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005036
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number005036
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: