1437597382 NPI number — DR. MARIA CARMEN VASCO P.T., D.P.T

Table of content: (NPI 1659630499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437597382 NPI number — DR. MARIA CARMEN VASCO P.T., D.P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VASCO
Provider First Name:
MARIA
Provider Middle Name:
CARMEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437597382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10880 HIGHWAY 789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82501-9466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-851-9008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOSHONI
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82649-8728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-851-9008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1478 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 2502 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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