MEDICARE: VINCE NIGRO PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	001260	IA

General Provider Information

NPI Number	:	1992012819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCE NIGRO PTA

Provider Business Mailing Address
First Line	:	5106 HWS CLEVELAND BLVD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5106 HWS CLEVELAND BLVD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3189
Country	:	US
Telephone Number	:	402-917-6220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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