MEDICARE: SEAN A TRUCANO MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01035900	NJ

General Provider Information

NPI Number	:	1386611069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN A TRUCANO MSPT

Provider Business Mailing Address
First Line	:	3929 NATHAN LN
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08361-7004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 W SHERMAN AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-6931
Country	:	US
Telephone Number	:	856-696-5656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	01/20/2021

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Directions to “ SEAN A TRUCANO MSPT” Practice Location

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