Healthcare Provider Details

I. General information

NPI: 1215238910
Provider Name (Legal Business Name): PATRICK E VIGIL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HIGHWAY 314 SW
LOS LUNAS NM
87031-9600
US

IV. Provider business mailing address

1220 CAMINO DEL LLANO
BELEN NM
87002-2727
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-0055
  • Fax: 505-866-0057
Mailing address:
  • Phone: 505-861-1200
  • Fax: 505-861-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3894
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: