Healthcare Provider Details

I. General information

NPI: 1972837789
Provider Name (Legal Business Name): VINCENT ROBERT CATTERUCCIA PHD, LNMT, ISCRS, NA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 E. SUNDANCE TRAIL SUITE D102
CAREFREE AZ
85377
US

IV. Provider business mailing address

40205 N EXPLORATION TRAIL
ANTHEM AZ
85086
US

V. Phone/Fax

Practice location:
  • Phone: 480-462-9894
  • Fax:
Mailing address:
  • Phone: 480-462-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1804
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number10470-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: