Individual
MR. RICHARD P VICENZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATHLETIC TRAINER
Contact information
Practice address
510 LINCOLN DRIVE, HERRIN, IL 62948
(618) 997-6800
(618) 998-9635
Mailing address
510 LINCOLN DRIVE, HERRIN, IL 62948
(618) 997-6800
(618) 998-9635
Taxonomy
Speciality
Code
Description
License number
State
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
Primary
096000258
IL
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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