DAVID IANNICCA

SURPRISE, AZ
NPI1245455666
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2081S0010X Physical Medicine & Rehabilitation, Sports Medicine
(Licence: VA  0126000756)
Enumeration Date2007-04-13
Last Update Date2007-07-08
Business Address
-- DAVID IANNICCA ATC
15946 N BULLARD AVE
SURPRISE, AZ 85374-8844
Phone number: 816-277-2954
Mailing Address
-- DAVID IANNICCA ATC
920 CENTER RD
EASTLAKE, OH 44095-2332
Phone number: 440-223-0569
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