Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1804 | IL |
NPI | 1972837789 |
---|---|
Provider Name | Vincent Robert Catteruccia |
First Address | Green Bay, WI 54303 |
Second Address | Green Bay, WI 54303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2009 |
Last Update Date | 25/09/2009 |