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General NPI Number Information
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NPI Number | 1679434401
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Entity Type | Individual
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Provider Name | MR. MICHAEL THOMAS RECASINO
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Gender | Male
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5285
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Country | US
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Telephone | 571-231-3224
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Fax |
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Provider Business Mailing Address
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Address Line | 4018 WALTER T BAHL
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City | SAN ANTONIO
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State | TX
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Zip | 78234-7840
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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