| Doctor Name: | VILMA BIADO VICENCIO |
| NPI Number: | 1104033489 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 011017-1 |
| Business Practice Address: | 35 Longwood Rd Middle Island, NY - 119532045 |
| Business Phone Number: | 6319240008 |
| Business Fax Number: | |
| Mailing Address: | 4 Susan Dr, WADING RIVER |
| State: | NY |
| Postal Code: | 117922130 |
| Phone Number: | 6318661900 |
| Fax Number: | |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 011017-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |