Provider Demographics
NPI:1386639706
Name:CACOLICE, PAUL ANDREW (AT,C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:CACOLICE
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1103
Mailing Address - Country:US
Mailing Address - Phone:860-841-3171
Mailing Address - Fax:
Practice Address - Street 1:304 PATTERSON HALL, EXERCISE AND REHAB SCIENCES
Practice Address - Street 2:SLIPPERY ROCK UNIVERSITY
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057
Practice Address - Country:US
Practice Address - Phone:724-738-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer