David Iannicca, ATC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

0126000756 Issued in VA

Practice address

15946 N Bullard Ave
Surprise, AZ 85374-8844

Phone

(816) 277-2954

NPI assigned

Apr 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245455666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 CENTER RD",
            "city": "EASTLAKE",
            "state": "OH",
            "postal_code": "440952332",
            "telephone_number": "440-223-0569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15946 N BULLARD AVE",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853748844",
            "telephone_number": "816-277-2954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IANNICCA",
        "first_name": "DAVID",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "VA",
            "license": "0126000756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ly Khanh Huynh, DMD
• Quy Huynh
• Stefan Iacob, PA-C
• Hanna Ian, N.M.D.
• Niccolo Iannello, DPT
• Rachel Iannucci, C.O.T.A.
• Geoff Ross Ibe, FNP-BC
• Haifaa Ibrahim
• Safi Ibrahim
• Ideal Dental Surprise PLLC

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.