Provider Demographics
NPI:1861551186
Name:VALA, VIBEKE (PT)
Entity type:Individual
Prefix:
First Name:VIBEKE
Middle Name:
Last Name:VALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 N.W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641
Mailing Address - Country:US
Mailing Address - Phone:352-376-6300
Mailing Address - Fax:352-372-6106
Practice Address - Street 1:1234 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4042
Practice Address - Country:US
Practice Address - Phone:352-376-6300
Practice Address - Fax:352-372-6106
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2379ZMedicare ID - Type Unspecified