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General NPI Number Information
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NPI Number | 1033377585
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Entity Type | Individual
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Provider Name | ANTHONY VIDAL PT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 1341 PARADISE RD
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City | EDENTON
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State | NC
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Zip | 27932-8503
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Country | US
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Telephone | 252-482-2538
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Fax |
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Provider Business Mailing Address
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Address Line | 944 SUMMERSIDE CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-6373
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Country | US
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Telephone |
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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 | 11128
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License Number State | NC
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