Provider Demographics
NPI:1548337009
Name:ARVISO, ANTHONY LIONEL (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LIONEL
Last Name:ARVISO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E HISTORIC HIGHWAY 66
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4883
Mailing Address - Country:US
Mailing Address - Phone:505-863-4199
Mailing Address - Fax:505-863-4196
Practice Address - Street 1:1900 E HISTORIC HIGHWAY 66
Practice Address - Street 2:SUITE 5
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4883
Practice Address - Country:US
Practice Address - Phone:505-863-4199
Practice Address - Fax:505-863-4196
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist