=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992887921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD JOSEPH VIGLIA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 W GOOD HOPE RD
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53209-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-228-8868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 S PHEASANT PL
-----------------------------------------------------
City | SAUKVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53080-1820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-284-2535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 31-19
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------