Provider Demographics
NPI:1477503738
Name:FARACI, VINCENT (ATC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:FARACI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MEAD RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9462
Mailing Address - Country:US
Mailing Address - Phone:802-888-1511
Mailing Address - Fax:
Practice Address - Street 1:337 COLLEGE HL
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656-9741
Practice Address - Country:US
Practice Address - Phone:802-635-1487
Practice Address - Fax:802-635-1497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00000732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer