Provider Demographics
NPI:1538461116
Name:MACCIO, JOSEPH RAYMOND (DPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:MACCIO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEW HAMPSHIRE AVENUE
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 AVENUE
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
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031348-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist