Healthcare Provider Details

I. General information

NPI: 1992887921
Provider Name (Legal Business Name): DONALD JOSEPH VIGLIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W GOOD HOPE RD
MILWAUKEE WI
53209-2831
US

IV. Provider business mailing address

321 S PHEASANT PL
SAUKVILLE WI
53080-1820
US

V. Phone/Fax

Practice location:
  • Phone: 414-228-8868
  • Fax:
Mailing address:
  • Phone: 262-284-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number31-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: