Provider Demographics
NPI:1417068917
Name:TRANCHITA, DAVID V (MA, PT, OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:TRANCHITA
Suffix:
Gender:M
Credentials:MA, PT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12060 W BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1042
Mailing Address - Country:US
Mailing Address - Phone:414-282-9590
Mailing Address - Fax:414-282-9348
Practice Address - Street 1:6520 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4523
Practice Address - Country:US
Practice Address - Phone:414-282-9590
Practice Address - Fax:414-282-9348
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3956-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist