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General NPI Number Information
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NPI Number | 1649360793
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Entity Type | Individual
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Provider Name | MICHAEL A VITA JR. PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 4208 OAKTHORNE WAY
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City | RALEIGH
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State | NC
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Zip | 27613-5922
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Country | US
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Telephone | 919-624-2358
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Fax | 919-787-1133
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Provider Business Mailing Address
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Address Line | 4208 OAKTHORNE WAY
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City | RALEIGH
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State | NC
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Zip | 27613-5922
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Country | US
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Telephone | 919-624-2358
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Fax | 919-787-1133
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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 | 7689
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License Number State | NC
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