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1245455666
DAVID IANNICCA
SURPRISE, AZ
NPI
1245455666
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine
(Licence: VA 0126000756)
Enumeration Date
2007-04-13
Last Update Date
2007-07-08
Business Address
-- DAVID IANNICCA ATC
15946 N BULLARD AVE
SURPRISE, AZ 85374-8844
Phone number: 816-277-2954
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Mailing Address
-- DAVID IANNICCA ATC
920 CENTER RD
EASTLAKE, OH 44095-2332
Phone number: 440-223-0569
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