Provider Demographics
NPI:1205036415
Name:KABBAZ, VINCENT (PT)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:KABBAZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MONONA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3554
Mailing Address - Country:US
Mailing Address - Phone:608-441-0032
Mailing Address - Fax:608-441-0034
Practice Address - Street 1:5900 MONONA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3554
Practice Address - Country:US
Practice Address - Phone:608-441-0032
Practice Address - Fax:608-441-0034
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5161-0242251X0800X
CAPT 282642251X0800X
IL070-0144632251X0800X
IN05004602A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic