Individual
MRS. LISA ANN VICENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
101 BROAD ST, PLATTSBURGH, NY 12901-2637
(518) 564-4152
(518) 564-2558
Mailing address
101 BROAD ST, PLATTSBURGH, NY 12901-2637
(518) 564-4152
(518) 564-2558
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000682-1
NY
Other
Enumeration date
11/19/2019
Last updated
11/19/2019
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