Provider Demographics
NPI:1790758407
Name:MUCCINO, ANDREW J (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:MUCCINO
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 1:1700 SOLON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4124
Mailing Address - Country:US
Mailing Address - Phone:305-849-0874
Mailing Address - Fax:
Practice Address - Street 1:1700 SOLON AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4124
Practice Address - Country:US
Practice Address - Phone:305-849-0874
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer