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NPI Code Detail

MEDICARE: ERIC ANTHONY VIAL MS,PT

MEDICARE: ERIC ANTHONY VIAL MS,PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT14879CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1171080100OTHERCAOWCP PROVIDER NUMBER

General Provider Information

NPI Number : 1003806597
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC ANTHONY VIAL MS,PT
Provider Business Mailing Address
First Line : 515 ASH ST
Second Line :
City : SUSANVILLE
State : CA
Zip : 96130-3711
Country : US
Telephone Number : 530-257-7711
Fax Number : 530-257-2170
Provider Business Practice Location Address
First Line : 1525 E WINDMILL LN STE 202
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-1903
Country : US
Telephone Number : 702-202-1280
Fax Number : 702-361-8596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 04/19/2022

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