Individual
MR. DENNIS ANTHONY VICIDOMINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.,C.
Contact information
Practice address
1905 SPLIT ROCK RD, LANCASTER, PA 17601-6421
(717) 898-5515
Mailing address
1905 SPLIT ROCK RD, LANCASTER, PA 17601-6421
(717) 898-5515
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT001392A
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22
—
PA
Enumeration date
08/15/2011
Last updated
08/15/2011
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