Provider Demographics
NPI:1326743121
Name:BOCCADIFUOCO, ERIC (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BOCCADIFUOCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SW LAKE CHARLES CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3429
Mailing Address - Country:US
Mailing Address - Phone:917-583-7945
Mailing Address - Fax:
Practice Address - Street 1:1537 NE CEDAR ST
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4808
Practice Address - Country:US
Practice Address - Phone:772-332-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist