1386639706 NPI number — PAUL ANDREW CACOLICE A.T.,C.

Table of content: PAUL ANDREW CACOLICE A.T.,C. (NPI 1386639706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386639706 NPI number — PAUL ANDREW CACOLICE A.T.,C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CACOLICE
Provider First Name:
PAUL
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.T.,C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386639706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
767 COTTONWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-841-3171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 PATTERSON HALL, EXERCISE AND REHAB SCIENCES
Provider Second Line Business Practice Location Address:
SLIPPERY ROCK UNIVERSITY
Provider Business Practice Location Address City Name:
SLIPPERY ROCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-738-4308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)