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General NPI Number Information
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NPI Number | 1942469234
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Entity Type | Individual
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Provider Name | JOHANNY VIZCARRONDO COLON
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Gender | Female
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 24011 MADACA LANE # 108
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954
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Country | US
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Telephone | 787-550-7835
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Fax |
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Provider Business Mailing Address
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Address Line | 24011 MADACA LANE # 108
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954
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Country | US
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Telephone | 787-550-7835
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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 | 1182
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License Number State | PR
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