Healthcare Provider Details

I. General information

NPI: 1992360820
Provider Name (Legal Business Name): BRICE JOY CALZARETTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N91W15750 FALLS PKWY
MENOMONEE FALLS WI
53051-2301
US

IV. Provider business mailing address

769 S MAIN ST
CEDAR GROVE WI
53013-1306
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-1100
  • Fax: 262-532-1409
Mailing address:
  • Phone: 847-809-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2526-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: