Provider Demographics
NPI:1093705535
Name:MACCIO PHYSCIAL THERAPY PLLC
Entity Type:Organization
Organization Name:MACCIO PHYSCIAL THERAPY PLLC
Other - Org Name:JOSEPH MACCIO PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER PLLC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MA PT DPMDT
Authorized Official - Phone:518-273-2121
Mailing Address - Street 1:1 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1754
Mailing Address - Country:US
Mailing Address - Phone:518-273-2121
Mailing Address - Fax:518-273-0701
Practice Address - Street 1:1 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1754
Practice Address - Country:US
Practice Address - Phone:518-273-2121
Practice Address - Fax:518-273-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
R55397Medicare UPIN
NYRA6653Medicare ID - Type Unspecified