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Individual

STEVEN A MIGNACCA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
P.T.

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT01117
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0015873
MEDICARE PTAN
RI
01
PT01117
STATE LICENSE NUMBER
RI
Enumeration date
02/08/2007
Last updated
12/14/2012
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