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General NPI Number Information
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NPI Number | 1003955725
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Entity Type | Individual
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Provider Name | STEPHEN A VIGHETTI PT, MTC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4020 GRANDE VISTA BLVD #114
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-1323
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Country | US
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Telephone | 904-315-3416
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 GRANDE VISTA BLVD #114
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-1323
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Country | US
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Telephone | 904-315-3416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT21615
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License Number State | FL
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