Provider Demographics
NPI:1588286868
Name:VIZECKY, CHRISTEL ANN (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:ANN
Last Name:VIZECKY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1901
Mailing Address - Country:US
Mailing Address - Phone:727-642-7853
Mailing Address - Fax:
Practice Address - Street 1:2101 W 41ST ST STE 4
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6195
Practice Address - Country:US
Practice Address - Phone:727-642-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist