Basic Information
| Provider Information | |||||||||
| NPI: | 1407108798 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VICIL | ||||||||
| FirstName: | FLORENCE | ||||||||
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| Credential: | CEP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1553 SAN LUIS RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323041369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522190128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1981 CAPITAL CIR NE | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504314709 | ||||||||
| FaxNumber: | 8504316325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2012 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Y00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Clinical Exercise Physiologist |
No ID Information.