Provider Demographics
NPI:1972837789
Name:CATTERUCCIA, VINCENT ROBERT (PHD, LNMT, ISCRS, NA)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:ROBERT
Last Name:CATTERUCCIA
Suffix:
Gender:M
Credentials:PHD, LNMT, ISCRS, NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40205 N EXPLORATION TRAIL
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:480-462-9894
Mailing Address - Fax:
Practice Address - Street 1:7301 E. SUNDANCE TRAIL
Practice Address - Street 2:SUITE D102
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-462-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1804226300000X
WI10470-146225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
270678586Medicare Oscar/Certification