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Mr. Gustavo Vidal, PT
Specialist in Wake Forest, North Carolina
NPI 1184657298

Gustavo Vidal is a Specialist based in Wake Forest, NC. Gustavo Vidal practices in Wake Forest, NC and has the professional credentials of PT. The NPI Number for Gustavo Vidal is 1184657298 and holds a License No. 8191 (North Carolina).

The current practice location address for Gustavo Vidal is 123 Capcom Ave Ste 2, Wake Forest, NC and can be reached out via phone at 919-551-4142 and via fax at 919-694-6417.

Location: 123 Capcom Ave Ste 2, Wake Forest, NC, 27587-3612
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1184657298
Provider Name
Gustavo Vidal
Credential
PT
Provider Entity Type
Individual
Gender
Male
Address
123 Capcom Ave Ste 2, Wake Forest, NC, 27587-3612
Phone Number
919-551-4142
Fax Number
919-694-6417
Provider Enumeration Date
07/09/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
078M3 01 NC BCBS PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
123 Capcom Ave Ste 2
City
Wake Forest
State
North Carolina
Zip
27587-6517
Phone Number
919-551-4142
Fax Number
919-694-6417
person
Provider Business Mailing Address Details
Address
123 Capcom Ave Ste 2
City
Wake Forest
State
North Carolina
Zip
27587-6517
Phone Number
919-551-4142
Fax Number
919-694-6417
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
8191 (North Carolina)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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