Basic Information
| Provider Information | |||||||||
| NPI: | 1336463751 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PATEL | ||||||||
| FirstName: | VYOMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13156 MORO CT | ||||||||
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| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347875016 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12184 LAKE UNDERHILL RD | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328255012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073823777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2010 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT25248 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.