Provider Demographics
NPI:1942457148
Name:VICENTE, JOSELITO (PT)
Entity type:Individual
Prefix:MR
First Name:JOSELITO
Middle Name:
Last Name:VICENTE
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 1:3560 DELAWARE ST
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3067
Mailing Address - Country:US
Mailing Address - Phone:409-899-1100
Mailing Address - Fax:409-899-1120
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 1002
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-899-1100
Practice Address - Fax:409-899-1120
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist