Provider Demographics
NPI:1477027928
Name:TRUNCALI, JAMES WALTER (LMT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WALTER
Last Name:TRUNCALI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W BRENDA LOOP
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0908
Mailing Address - Country:US
Mailing Address - Phone:928-300-9597
Mailing Address - Fax:
Practice Address - Street 1:601 E PICCADILLY DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5964
Practice Address - Country:US
Practice Address - Phone:928-300-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-06788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty