Provider Demographics
NPI:1336352756
Name:VANO, AVITO VELOSO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:AVITO
Middle Name:VELOSO
Last Name:VANO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:MR
Other - First Name:AVITO
Other - Middle Name:VELOSO
Other - Last Name:VANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:9460 REDHAWK BEND LANE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810
Mailing Address - Country:US
Mailing Address - Phone:727-810-0173
Mailing Address - Fax:863-858-9406
Practice Address - Street 1:9460 REDHAWK BEND LANE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810
Practice Address - Country:US
Practice Address - Phone:727-810-0173
Practice Address - Fax:863-858-9406
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist