Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT21073 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT21073 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT21073 | FL |
NPI | 1457565095 |
---|---|
Provider Name | Mr. Craig S Vecchiarelli |
First Address | Zephyrhills, FL 33542-7505 |
Second Address | Tampa, FL 33606-2413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104863800 | (05) | FL |
L0703 | MEDICARE (01) | FL |
Y911W | BLUE CROSS BLUE SHIELD (01) | FL |