Provider Demographics
NPI:1588375919
Name:VIADO, GASPAR JOSE (PT)
Entity type:Individual
Prefix:
First Name:GASPAR
Middle Name:JOSE
Last Name:VIADO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:VIADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:675 GROVES END LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5281
Mailing Address - Country:US
Mailing Address - Phone:407-718-6596
Mailing Address - Fax:
Practice Address - Street 1:701 LAKE PORT BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7674
Practice Address - Country:US
Practice Address - Phone:352-728-3366
Practice Address - Fax:352-435-0206
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist