Healthcare Provider Details

I. General information

NPI: 1023243722
Provider Name (Legal Business Name): JHOANA VILORIA CARLOS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 SE COURT AVE.
PENDLETON OR
97801
US

IV. Provider business mailing address

438 SW 5TH ST APT A7
PENDLETON OR
97801-2073
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-4100
  • Fax:
Mailing address:
  • Phone: 503-803-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5571
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 60042194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: