Provider Demographics
NPI:1639454168
Name:VUCINOVICH, KERRY (LMT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:VUCINOVICH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DRINKWATER RD
Mailing Address - Street 2:
Mailing Address - City:BAY SAINT LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1640
Mailing Address - Country:US
Mailing Address - Phone:228-547-4727
Mailing Address - Fax:228-255-2633
Practice Address - Street 1:300 DRINKWATER RD
Practice Address - Street 2:
Practice Address - City:BAY SAINT LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1640
Practice Address - Country:US
Practice Address - Phone:228-547-4727
Practice Address - Fax:228-255-2633
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS929225700000X
LALA3751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist