Provider Demographics
NPI:1982335311
Name:PIACENTINO, MICAELA (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:PIACENTINO
Suffix:
Gender:F
Credentials:MAT, 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:PSC 103 BOX 5328
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09603-0054
Mailing Address - Country:US
Mailing Address - Phone:314-570-8683
Mailing Address - Fax:
Practice Address - Street 1:AVIANO AIR BASE
Practice Address - Street 2:AREA F BUILDING 1466
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09603
Practice Address - Country:US
Practice Address - Phone:314-570-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240323292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer