Basic Information
| Provider Information | |||||||||
| NPI: | 1154667590 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VASQUEZ | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | VALENTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 OLIVE CHAPEL RD | ||||||||
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| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275028586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195358758 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 S 17TH ST | ||||||||
| Address2: | UNIT 2 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195358758 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2012 | ||||||||
| LastUpdateDate: | 01/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11897 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | P14944 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.