Christian Pocholo Vicmudo

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT38276 Issued in FL

Practice address

5165 Adanson St
Orlando, FL 32804-1331

Phone

(352) 394-0212

NPI assigned

Jun 7, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1639808470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120547",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347120547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5165 ADANSON ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328041331",
            "telephone_number": "352-394-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICMUDO",
        "first_name": "CHRISTIAN POCHOLO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT38276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arlene A Vickers, ARNP
• Donald Crisp Vickers Jr., RPH BCNSP
• Ileana Vickers, APRN
• Michelle Marlo Boucher Vickers, NCC, CRC, LMHC
• Odessa Lee Vickery-Merrigan
• Victor N. Alvarado MD 'LLC'
• Noelle Ruth Victor-Nicolas
• Elaine Victor, BEHAVIORAL TECH
• Adriana Victoria
• Natalie Victoria

• Physical Therapist in Orlando, FL
• Providers in Orlando, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.