Provider Demographics
NPI:1730142217
Name:SECKER, VINCE (PT)
Entity Type:Individual
Prefix:MR
First Name:VINCE
Middle Name:
Last Name:SECKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 W 24TH ST
Mailing Address - Street 2:STE 10
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6154
Mailing Address - Country:US
Mailing Address - Phone:928-344-1656
Mailing Address - Fax:928-344-5072
Practice Address - Street 1:2281 W 24TH ST
Practice Address - Street 2:STE 10
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6154
Practice Address - Country:US
Practice Address - Phone:928-344-1656
Practice Address - Fax:928-344-5072
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0293620OtherBLUE CROSS OF AZ
AZ28383Medicare ID - Type UnspecifiedMEDICARE