Provider Demographics
NPI:1992360820
Name:CALZARETTA, BRICE JOY
Entity type:Individual
Prefix:
First Name:BRICE
Middle Name:JOY
Last Name:CALZARETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53013-1306
Mailing Address - Country:US
Mailing Address - Phone:847-809-9160
Mailing Address - Fax:
Practice Address - Street 1:N91W15750 FALLS PKWY
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2301
Practice Address - Country:US
Practice Address - Phone:262-532-1100
Practice Address - Fax:262-532-1409
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
WI2526-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer