Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 1543 | MN |
N | 2251S0007X | Physical Therapist - Sports | 1790-024 | WI |
NPI | 1043384985 |
---|---|
Provider Name | Mr. Gregory Stephan Vergamini |
First Address | Superior, WI 54880-5335 |
Second Address | Superior, WI 54880-5335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |