Provider Demographics
NPI:1548551252
Name:VIERNES, JOHN VINCENT B III (DPT)
Entity type:Individual
Prefix:MR
First Name:JOHN VINCENT
Middle Name:B
Last Name:VIERNES
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4943 KOKOMO DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1852
Mailing Address - Country:US
Mailing Address - Phone:808-230-5482
Mailing Address - Fax:
Practice Address - Street 1:4943 KOKOMO DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1852
Practice Address - Country:US
Practice Address - Phone:808-230-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist