Organization
PEDIATRIC LINKS,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AGNES LUCAS VIGILIA-MARAYA P.T. (ADMINISTRATOR/OWNER/PRACTITIONER)
(260) 418-8051
Entity
Organization
Contact information
Practice address
7317 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6237
(260) 418-8051
(260) 489-3704
Mailing address
7317 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6237
(260) 418-8051
(260) 489-3704
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
PT05002613A
IN
261QD1600X
Developmental Disabilities Clinic/Center
Primary
PT05002613A
IN
Other
Enumeration date
05/10/2011
Last updated
05/10/2011
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