Healthcare Provider Details

I. General information

NPI: 1801158159
Provider Name (Legal Business Name): VIM PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 KEOTA DR
AUSTIN TX
78749-3851
US

IV. Provider business mailing address

4509 KEOTA DR
AUSTIN TX
78749-3851
US

V. Phone/Fax

Practice location:
  • Phone: 512-740-6338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1151285
License Number StateTX

VIII. Authorized Official

Name: ERIKA AGUILAR
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 512-740-6338