Provider Demographics
NPI:1558444356
Name:SACCO, RENARD MICHAEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:RENARD
Middle Name:MICHAEL
Last Name:SACCO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:35 IRONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2946
Mailing Address - Country:US
Mailing Address - Phone:610-779-9144
Mailing Address - Fax:610-683-4664
Practice Address - Street 1:KUTZTOWN UNIVERSITY
Practice Address - Street 2:KEYSTONE HALL, SPORTS MEDICINE OFFICE, RM 120
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530
Practice Address - Country:US
Practice Address - Phone:610-683-4085
Practice Address - Fax:610-683-4664
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PART000505A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer