Provider Demographics
NPI:1144775073
Name:SACCOCIO, KRYSTEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:SACCOCIO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10745 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5922
Mailing Address - Country:US
Mailing Address - Phone:954-243-3650
Mailing Address - Fax:
Practice Address - Street 1:12797 FOREST HILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4763
Practice Address - Country:US
Practice Address - Phone:561-296-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist