Provider Demographics
NPI:1710711163
Name:VIDACURA THERAPIES LLC
Entity type:Organization
Organization Name:VIDACURA THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LORETO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:765-210-8228
Mailing Address - Street 1:1802 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3958
Mailing Address - Country:US
Mailing Address - Phone:765-210-8228
Mailing Address - Fax:
Practice Address - Street 1:2300 VILLAGE PT
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-0260
Practice Address - Country:US
Practice Address - Phone:765-210-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty