Individual
MS. ADRIENNE VACCA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1500 GRAND CENTRAL AVE, SUITE 101, VIENNA, WV 26105-1079
(304) 295-3060
(304) 295-3068
Mailing address
1500 GRAND CENTRAL AVE, SUITE 101, VIENNA, WV 26105-1079
(304) 295-3060
(304) 295-3068
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
002475
WV
225100000X
Physical Therapist
Primary
10914
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2564514
—
OH
05
—
3810002352
—
WV
Enumeration date
05/11/2006
Last updated
07/08/2007
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