Provider Demographics
NPI:1104438217
Name:DA VITORIA LOBO, TERRILL (LAT, ATC, CAT(C))
Entity type:Individual
Prefix:MR
First Name:TERRILL
Middle Name:
Last Name:DA VITORIA LOBO
Suffix:
Gender:M
Credentials:LAT, ATC, CAT(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RYLAND ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1643
Mailing Address - Country:US
Mailing Address - Phone:702-354-3279
Mailing Address - Fax:
Practice Address - Street 1:401 RYLAND ST STE 200A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1643
Practice Address - Country:US
Practice Address - Phone:702-354-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05062942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer