Provider Demographics
NPI:1861932352
Name:VITALE, REECE (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:REECE
Middle Name:
Last Name:VITALE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 SAINT VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-2825
Mailing Address - Country:US
Mailing Address - Phone:985-513-4163
Mailing Address - Fax:
Practice Address - Street 1:32695 GRAHAM ST
Practice Address - Street 2:
Practice Address - City:WHITE CASTLE
Practice Address - State:LA
Practice Address - Zip Code:70788-2211
Practice Address - Country:US
Practice Address - Phone:985-513-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3023652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer