Provider Demographics
NPI:1356090344
Name:COLUCCIO, ROCCO (PT, MA)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:
Last Name:COLUCCIO
Suffix:
Gender:M
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3405
Mailing Address - Country:US
Mailing Address - Phone:347-262-0069
Mailing Address - Fax:
Practice Address - Street 1:1457 85TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3405
Practice Address - Country:US
Practice Address - Phone:347-262-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38323225100000X
NY012847-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist