Provider Demographics
NPI:1194054007
Name:DIGIOVANNI, VINCENT PAUL (MS, L-ATC, CSCS)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:PAUL
Last Name:DIGIOVANNI
Suffix:
Gender:M
Credentials:MS, L-ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 SW HEREFORDSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610
Mailing Address - Country:US
Mailing Address - Phone:785-273-0330
Mailing Address - Fax:913-541-3108
Practice Address - Street 1:10500 LACKMAN RD
Practice Address - Street 2:JC PENNEY MEDICAL OFFICE
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219
Practice Address - Country:US
Practice Address - Phone:913-541-2365
Practice Address - Fax:913-541-3108
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
KS24-003922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No133N00000XDietary & Nutritional Service ProvidersNutritionist