Provider Demographics
NPI:1467991737
Name:VECCHIARELLI, CARLO EUGENE III (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CARLO
Middle Name:EUGENE
Last Name:VECCHIARELLI
Suffix:III
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 E ACAMPO RD
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9709
Mailing Address - Country:US
Mailing Address - Phone:209-603-9552
Mailing Address - Fax:
Practice Address - Street 1:6136 E ACAMPO RD
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9709
Practice Address - Country:US
Practice Address - Phone:209-603-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-19
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist