Provider Demographics
NPI:1528456662
Name:MICOZZI, ANGELO
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:MICOZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MEMORIAL DR STE 7843
Mailing Address - Street 2:
Mailing Address - City:CULLOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723-8911
Mailing Address - Country:US
Mailing Address - Phone:336-817-3977
Mailing Address - Fax:
Practice Address - Street 1:245 MEMORIAL DR STE 7843
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723-8911
Practice Address - Country:US
Practice Address - Phone:336-817-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer