Provider Demographics
NPI:1427639798
Name:VBNC PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:VBNC PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ROJAS MIERES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-715-9864
Mailing Address - Street 1:5910 CHEROKEE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6205
Mailing Address - Country:US
Mailing Address - Phone:360-915-7369
Mailing Address - Fax:360-688-7499
Practice Address - Street 1:4770 YELM HWY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4986
Practice Address - Country:US
Practice Address - Phone:509-715-9864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy