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General NPI Number Information
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NPI Number | 1285094250
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Entity Type | Individual
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Provider Name | JEFFREY GIOVANNUCCI ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 250 UNIVERSITY AVE
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City | CALIFORNIA
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State | PA
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Zip | 15419-1341
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Country | US
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Telephone | 724-938-4011
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Fax |
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Provider Business Mailing Address
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Address Line | 818 SHERIDAN ST
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City | MONONGAHELA
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State | PA
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Zip | 15063-2239
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Country | US
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Telephone | 724-207-3719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | RT005780
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License Number State | PA
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