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NPI Code Detail

MEDICARE: GASPAR JOSE VIADO PT

MEDICARE: GASPAR JOSE VIADO 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 TherapistPT12342FL

General Provider Information

NPI Number : 1588375919
Entity Type Code : Individual
Provider Name (Legal Business Name) : GASPAR JOSE VIADO PT
Provider Business Mailing Address
First Line : 675 GROVES END LN
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-5281
Country : US
Telephone Number : 407-718-6596
Fax Number :
Provider Business Practice Location Address
First Line : 701 LAKE PORT BLVD
Second Line :
City : LEESBURG
State : FL
Zip : 34748-7674
Country : US
Telephone Number : 352-728-3366
Fax Number : 352-435-0206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2022
Last Update Date : 12/06/2022

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