Provider Demographics
NPI:1952290652
Name:RIVECCO, VITO A (PTA)
Entity type:Individual
Prefix:
First Name:VITO
Middle Name:A
Last Name:RIVECCO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4414
Mailing Address - Country:US
Mailing Address - Phone:262-220-1298
Mailing Address - Fax:
Practice Address - Street 1:2408 4 MILE RD
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:WI
Practice Address - Zip Code:53402-2091
Practice Address - Country:US
Practice Address - Phone:262-687-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4165-19225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist