Healthcare Provider Details

I. General information

NPI: 1154399764
Provider Name (Legal Business Name): MICHAEL JOSEPH VITTORINO ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 FIELD CLUB CIR
MC KEES ROCKS PA
15136-1034
US

IV. Provider business mailing address

241 FIELD CLUB CIR
MC KEES ROCKS PA
15136-1034
US

V. Phone/Fax

Practice location:
  • Phone: 412-262-8514
  • Fax:
Mailing address:
  • Phone: 412-262-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001726A
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: